BioMed Research International: Epidemiology The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Survival of Mexican Children with Acute Lymphoblastic Leukaemia under Treatment with the Protocol from the Dana-Farber Cancer Institute 00-01 Thu, 26 Mar 2015 11:21:14 +0000 Our aim in this paper is to describe the results of treatment of acute lymphoblastic leukaemia (ALL) in Mexican children treated from 2006 to 2010 under the protocol from the Dana-Farber Cancer Institute (DFCI) 00-01. The children were younger than 16 years of age and had a diagnosis of ALL de novo. The patients were classified as standard risk if they were 1–9.9 years old and had a leucocyte count <50 × 109/L, precursor B cell immunophenotype, no mediastinal mass, CSF free of blasts, and a good response to prednisone. The rest of the patients were defined as high risk. Of a total of 302 children, 51.7% were at high risk. The global survival rate was 63.9%, and the event-free survival rate was 52.3% after an average follow-up of 3.9 years. The percentages of patients who died were 7% on induction and 14.2% in complete remission; death was associated mainly with infection (21.5%). The relapse rate was 26.2%. The main factor associated with the occurrence of an event was a leucocyte count >100 × 109/L. The poor outcomes were associated with toxic death during induction, complete remission, and relapse. These factors remain the main obstacles to the success of this treatment in our population. Elva Jiménez-Hernández, Ethel Zulie Jaimes-Reyes, José Arellano-Galindo, Xochiketzalli García-Jiménez, Héctor Manuel Tiznado-García, María Teresa Dueñas-González, Octavio Martínez Villegas, Berenice Sánchez-Jara, Vilma Carolina Bekker-Méndez, María Guadalupe Ortíz-Torres, Antonio Ortíz-Fernández, Teresa Marín-Palomares, and Juan Manuel Mejía-Aranguré Copyright © 2015 Elva Jiménez-Hernández et al. All rights reserved. Survival of Mexican Children with Acute Myeloid Leukaemia Who Received Early Intensification Chemotherapy and an Autologous Transplant Mon, 02 Mar 2015 06:53:53 +0000 Background. In Mexico and other developing countries, few reports of the survival of children with acute leukaemia exist. Objective. We aimed at comparing the disease-free survival of children with acute myeloid leukaemia who, in addition to being treated with the Latin American protocol of chemotherapy and an autologous transplant, either underwent early intensified chemotherapy or did not undergo such treatment. Procedure. This was a cohort study with a historical control group, forty patients, less than 16 years old. Group A (20 patients), diagnosed in the period 2005–2007, was treated with the Latin American protocol of chemotherapy with an autologous transplant plus early intensified chemotherapy: high doses of cytarabine and mitoxantrone. Group B (20 patients), diagnosed in the period 1999–2004, was treated as Group A, but without the early intensified chemotherapy. Results. Relapse-free survival for Group A was 90% whereas that for Group B it was 60% (). Overall survival for Group A (18, 90%) was higher than that for Group B (60%). Complete remission continued for two years of follow-up. Conclusions. Relapse-free survival for paediatric patients treated with the Latin American protocol of chemotherapy with an autologous transplant plus early intensified chemotherapy was higher than that for those who did not receive early intensified chemotherapy. Elva Jiménez-Hernández, María Teresa Dueñas-González, José Arellano-Galindo, María Elena Medrano-Ortíz-De-Zárate, Vilma Carolina Bekker-Méndez, Adolfina Berges-García, Karina Solís-Labastida, Berenice Sánchez-Jara, Héctor Manuel Tiznado-García, Ethel Zulie Jaimes-Reyes, Xochiketzalli García-Jiménez, Laura Espinoza-Hernández, Nora Nancy Núñez-Villegas, Sergio Franco-Ornelas, Ruy Xavier Pérez-Casillas, Octavio Martínez Villegas, Teresa Marin Palomares, and Juan Manuel Mejía-Aranguré Copyright © 2015 Elva Jiménez-Hernández et al. All rights reserved. Predicting Psychotic-Like Experiences during Sensory Deprivation Tue, 24 Feb 2015 09:37:40 +0000 Aims. This study aimed to establish the contribution of hallucination proneness, anxiety, suggestibility, and fantasy proneness to psychotic-like experiences (PLEs) reported during brief sensory deprivation. Method. Twenty-four high and 22 low hallucination-prone participants reported on PLEs occurring during brief sensory deprivation and at baseline. State/trait anxiety, suggestibility, and fantasy proneness were also measured. Results. Both groups experienced a significant increase in PLEs in sensory deprivation. The high hallucination prone group reported more PLEs both at baseline and in sensory deprivation. They also scored significantly higher on measures of state/trait anxiety, suggestibility, and fantasy proneness, though these did not explain the effects of group or condition. Regression analysis found hallucination proneness to be the best predictor of the increase in PLEs, with state anxiety also being a significant predictor. Fantasy proneness and suggestibility were not significant predictors. Conclusion. This study suggests the increase in PLEs reported during sensory deprivation reflects a genuine aberration in perceptual experience, as opposed to increased tendency to make false reports due to suggestibility of fantasy proneness. The study provides further support for the use of sensory deprivation as a safe and effective nonpharmacological model of psychosis. Christina Daniel and Oliver J. Mason Copyright © 2015 Christina Daniel and Oliver J. Mason. All rights reserved. Maternal Glucose during Pregnancy and after Delivery in Women with Gestational Diabetes Mellitus on Overweight Status of Their Children Mon, 23 Feb 2015 07:30:32 +0000 Objective. To examine the association of maternal glycemia during pregnancy and after delivery with anthropometry in the offspring of mothers with gestational diabetes mellitus (GDM). Methods. A total of 1,263 GDM mothers and their children finished the health survey at 1–5 years after delivery. Results. Offspring of GDM mothers who were diagnosed with diabetes during pregnancy had higher prevalence of overweight, higher mean weight for height scores, and higher mean BMI for age scores at 1–5 years old than the offspring of GDM mothers who were diagnosed with impaired glucose tolerance (IGT) during pregnancy. Offspring of GDM mothers who developed diabetes 1–5 years after delivery had higher mean values of scores for weight for height and BMI for age at 1–5 years old than the offspring of GDM mothers who had normal glucose or prediabetes after delivery. Conclusions. Offspring of GDM mothers who were diagnosed with diabetes during pregnancy or after delivery had an increased risk of childhood overweight or weight gain at 1–5 years old compared with children of GDM mothers with IGT during pregnancy or with normal glucose or prediabetes after delivery. Shuang Zhang, Huikun Liu, Cuiping Zhang, Leishen Wang, Nan Li, Junhong Leng, Yi Li, Gongshu Liu, Xiangwei Fan, Zhijie Yu, Xilin Yang, Andrea A. Baccarelli, Lifang Hou, and Gang Hu Copyright © 2015 Shuang Zhang et al. All rights reserved. COMT-by-Sex Interaction Effect on Psychosis Proneness Thu, 05 Feb 2015 06:22:12 +0000 Schizotypy phenotypes in the general population share etiopathogenic mechanisms and risk factors with schizophrenia, supporting the notion of psychosis as a continuum ranging from nonclinical to clinical deviance. Catechol-O-methyltransferase (COMT) is a candidate susceptibility gene for schizophrenia that is involved in the regulation of dopamine in the prefrontal cortex. Several recent studies have reported a sex difference in the impact of COMT genotype on psychiatric and cognitive phenotypes and personality traits. The present study investigated the association of COMT Val158Met (rs4680) with psychometric positive and negative schizotypy and psychotic experiences in a sample of 808 nonclinical young adults. The main finding was that sex moderates the association of COMT genotype with the negative dimension of both schizotypy and psychotic experiences. Male subjects carrying the Val allele tended to score higher on the negative dimension of both trait and symptom-like measures. The results from the present study are consistent with recent work suggesting an association between negative schizotypy and diminished prefrontal dopamine availability. They support the idea that a biological differentiation underlies the positive and negative schizotypy dimensions. Additionally, these findings contribute to the growing literature on sex-specific effects of COMT on the predisposition to psychiatric disorders and personality traits. Marta de Castro-Catala, Neus Barrantes-Vidal, Tamara Sheinbaum, Artal Moreno-Fortuny, Thomas R. Kwapil, and Araceli Rosa Copyright © 2015 Marta de Castro-Catala et al. All rights reserved. Environmental Epidemiology of Intestinal Schistosomiasis in Uganda: Population Dynamics of Biomphalaria (Gastropoda: Planorbidae) in Lake Albert and Lake Victoria with Observations on Natural Infections with Digenetic Trematodes Sun, 01 Feb 2015 10:17:39 +0000 This study documented the population dynamics of Biomphalaria and associated natural infections with digenetic trematodes, along the shores of Lake Albert and Lake Victoria, recording local physicochemical factors. Over a two-and-a-half-year study period with monthly sampling, physicochemical factors were measured at 12 survey sites and all freshwater snails were collected. Retained Biomphalaria were subsequently monitored in laboratory aquaria for shedding trematode cercariae, which were classified as either human infective (Schistosoma mansoni) or nonhuman infective. The population dynamics of Biomphalaria differed by location and by lake and had positive relationship with pH () in both lakes and negative relationship with conductivity () in Lake Albert. Of the Biomphalaria collected in Lake Albert , 8.9% were infected with digenetic trematodes of which 15.8% were shedding S. mansoni cercariae and 84.2% with nonhuman infective cercariae. In Lake Victoria, 2.1% of collected Biomphalaria   were infected with digenetic trematodes with 13.9% shedding S. mansoni cercariae, 85.7% shedding nonhuman infective cercariae, and 0.4% of infected snails shedding both types of cercariae. Upon morphological identification, species of Biomphalaria infected included B. sudanica, B. pfeifferi, and B. stanleyi in Lake Albert and B. sudanica, B. pfeifferi, and B. choanomphala in Lake Victoria. The study found the physicochemical factors that influenced Biomphalaria population and infections. The number and extent of snails shedding S. mansoni cercariae illustrate the high risk of transmission within these lake settings. For better control of this disease, greater effort should be placed on reducing environmental contamination by improvement of local water sanitation and hygiene. Candia Rowel, Besigye Fred, Martha Betson, Jose C. Sousa-Figueiredo, Narcis B. Kabatereine, and J. Russell Stothard Copyright © 2015 Candia Rowel et al. All rights reserved. Gender-Specific Associations of Serum Antibody to Porphyromonas gingivalis and Inflammatory Markers Sat, 31 Jan 2015 06:51:25 +0000 It remains unclear whether serum antibody titer against Porphyromonas gingivalis (Pg) and inflammatory components lead to periodontal deterioration in each gender, as periodontal and systemic status is influenced by gender. The present study investigates the gender-specific probable effects of titer against Pg and inflammatory markers on periodontal health status in a longitudinal study. A retrospective study design was used. At two time points over an 8-year period (in 2003 and 2011), 411 individuals (295 males with a mean age of 57.6 ± 11.2 years and 116 females with a mean age of 59.2 ± 10.3 years) were surveyed. Periodontal status, serum antibody titer against Pg, and high-sensitive C-reactive protein (hsCRP) were evaluated. Poisson regression analyses revealed that the elevated titer against Pg and hsCRP significantly predicted the persistence of periodontal disease 8 years later in females with periodontal disease in 2003. Elevated hsCRP was significantly associated with the incidence of periodontal disease 8 years later in females who were periodontally healthy in 2003. Males had a weaker association among titer against Pg, inflammatory markers, and periodontal disease. These findings suggest that immune response to Pg infection in addition to inflammatory components affects periodontal deterioration in females. Michiko Furuta, Yoshihiro Shimazaki, Shunichi Tanaka, Kenji Takeuchi, Yukie Shibata, Toru Takeshita, Fusanori Nishimura, and Yoshihisa Yamashita Copyright © 2015 Michiko Furuta et al. All rights reserved. Examination of the Factor Structure of the Schizotypal Personality Questionnaire among British and Trinidadian Adults Wed, 28 Jan 2015 06:53:30 +0000 Much debate in schizotypal research has centred on the factor structure of the Schizotypal Personality Questionnaire (SPQ), with research variously showing higher-order dimensionality consisting of two to seven dimensions. In addition, cross-cultural support for the stability of those factors remains limited. Here, we examined the factor structure of the SPQ among British and Trinidadian adults. Participants from a White British subsample resident in the UK and from an African Caribbean subsample resident in Trinidad completed the SPQ. The higher-order factor structure of the SPQ was analysed through confirmatory factor analysis, followed by multiple-group analysis for the model of best fit. Between-group differences for sex and ethnicity were investigated using multivariate analysis of variance in relation to the higher-order domains. The model of best-fit was the four-factor structure, which demonstrated measurement invariance across groups. Additionally, these data had an adequate fit for two alternative models: (a) 3-factor and (b) modified 4-factor model. The British subsample had significantly higher scores across all domains than the Trinidadian group, and men scored significantly higher on the disorganised domain than women. The four-factor structure received confirmatory support and, importantly, support for use with populations varying in ethnicity and culture. David Barron, Viren Swami, Tony Towell, Gerard Hutchinson, and Kevin D. Morgan Copyright © 2015 David Barron et al. All rights reserved. The Melbourne Assessment of Schizotypy in Kids: A Useful Measure of Childhood Schizotypal Personality Disorder Tue, 06 Jan 2015 06:27:49 +0000 Despite being identified as a high risk cohort for psychosis, there has been relatively little research on the clinical presentation and assessment of Schizotypal Personality Disorder (SPD) in childhood. The current study aimed to develop a measure of childhood SPD (Melbourne Assessment of Schizotypy in Kids (MASK)) and assess discriminant validity against another neurodevelopmental disorder, autism spectrum disorder (ASD). Sixty-eight children aged between 5 and 12 (21 SPD, 15 ASD, and 32 typically developing) and their parents were administered the MASK. The MASK is a 57-item semistructured interview that obtains information from the child, their parents, and the clinician. The results showed high internal consistency for the MASK and higher scores in the SPD group. A factor analysis revealed two MASK factors: social/pragmatic symptoms and positive schizotypal symptoms. Both factors were associated with SPD, while only the social/pragmatic factor was associated with ASD. Within the two clinical groups, a receiver operating characteristic curve showed that the MASK (cut-off score: 132 out of 228) was a good indicator of SPD diagnosis. These preliminary MASK findings were reliable and consistent and suggest that childhood SPD is characterised by complex symptomology distinguishable from ASD. Harvey P. Jones, Renee R. Testa, Nola Ross, Marc L. Seal, Christos Pantelis, and Bruce Tonge Copyright © 2015 Harvey P. Jones et al. All rights reserved. EBV, HCMV, HHV6, and HHV7 Screening in Bone Marrow Samples from Children with Acute Lymphoblastic Leukemia Thu, 18 Sep 2014 08:31:19 +0000 Acute lymphoblastic leukemia (ALL) is the most common cancer in childhood worldwide and Mexico has reported one of the highest incidence rates. An infectious etiology has been suggested and supported by epidemiological evidences; however, the identity of the involved agent(s) is not known. We considered that early transmitted lymphotropic herpes viruses were good candidates, since transforming mechanisms have been described for them and some are already associated with human cancers. In this study we interrogated the direct role of EBV, HCMV, HHV6, and HHV7 human herpes viruses in childhood ALL. Viral genomes were screened in 70 bone marrow samples from ALL patients through standard and a more sensitive nested PCR. Positive samples were detected only by nested PCR indicating a low level of infection. Our result argues that viral genomes were not present in all leukemic cells, and, hence, infection most likely was not part of the initial genetic lesions leading to ALL. The high statistical power of the study suggested that these agents are not involved in the genesis of ALL in Mexican children. Additional analysis showed that detected infections or coinfections were not associated with prognosis. A. Morales-Sánchez, E. N. Pompa-Mera, A. Fajardo-Gutiérrez, F. J. Alvarez-Rodríguez, V. C. Bekker-Méndez, J. de Diego Flores-Chapa, J. Flores-Lujano, E. Jiménez-Hernández, J. G. Peñaloza-González, M. C. Rodríguez-Zepeda, J. R. Torres-Nava, M. M. Velázquez-Aviña, R. Amador-Sánchez, M. Alvarado-Ibarra, N. Reyes-Zepeda, R. M. Espinosa-Elizondo, M. L. Pérez-Saldivar, J. C. Núñez-Enríquez, J. M. Mejía-Aranguré, and E. M. Fuentes-Pananá Copyright © 2014 A. Morales-Sánchez et al. All rights reserved. CpG Island Methylator Phenotype and Prognosis of Colorectal Cancer in Northeast China Thu, 28 Aug 2014 15:13:33 +0000 Purpose. To investigate the association between CpG island methylator phenotype (CIMP) and the overall survival of sporadic colorectal cancer (CRC) in Northeast China. Methods. 282 sporadic CRC patients were recruited in this study. We selected MLH1, MGMT, p16, APC, MINT1, MINT31, and RUNX3 as the CIMP panel markers. The promoter methylation was assessed by methylation sensitive high resolution melting (MS-HRM). Proportional hazards-regression models were fitted with computing hazard ratios (HR) and the corresponding 95% confidence intervals (95% CI). Results. 12.77% (36/282) of patients were CIMP-0, 74.1% (209/282) of patients were CIMP-L, and 13.12% (37/282) of patients were CIMP-H. The five-year survival of the 282 CRC patients was 58%. There was significant association between APC gene promoter methylation and CRC overall survival (HR = 1.61; 95% CI: 1.05–2.46; ). CIMP-H was significantly associated with worse prognosis compared to CIMP-0 (HR = 3.06; 95% CI: 1.19–7.89; ) and CIMP-L (HR = 1.97; 95% CI: 1.11–3.48; ), respectively. While comparing with the combine of CIMP-L and CIMP-0 (CIMP-L/0), CIMP-H also presented a worse prognosis (HR = 2.31; 95% CI: 1.02–5.24; ). Conclusion. CIMP-H may be a predictor of a poor prognosis of CRC in Northeast China patients. Xia Li, Fulan Hu, Yibaina Wang, Xiaoping Yao, Zuoming Zhang, Fan Wang, Guizhi Sun, Bin-Bin Cui, Xinshu Dong, and Yashuang Zhao Copyright © 2014 Xia Li et al. All rights reserved. Clinical Utility of Ammonia Concentration as a Diagnostic Test in Monitoring of the Treatment with L-Asparaginase in Children with Acute Lymphoblastic Leukemia Wed, 23 Jul 2014 07:03:02 +0000 L-asparaginase (ASP) is an enzyme used as one of the basic regimens in the acute lymphoblastic leukemia (ALL) therapy. Because of the possibility of the enzyme inactivation by antibodies, monitoring of ASP activity is essential. The aim of the study was to examine if plasma concentration of ammonia, a direct product of the reaction catalyzed by ASP, can be used in the assessment of ASP activity. A group of 87 patients with acute lymphoblastic leukemia treated in the Department of Pediatric Oncology and Hematology in Krakow was enrolled to the study. ASP activity and ammonia concentration were measured after ASP administrations during induction. A positive correlation was found between the ammonia concentration and ASP activity (; ) and between the medium values of ammonia concentration and ASP activity (; ). The analysis of ROC curves revealed the moderate accuracy of the ammonia concentration values in the ASP activity assessment. It was also found that the medium value of ammonia concentrations can be useful in identification of the patients with low (<100 IU/L) and undetectable (<30 IU/L) ASP activity. The plasma ammonia concentration may reflect ASP activity and can be useful when a direct measurement of the activity is unavailable. Małgorzata Czogała, Walentyna Balwierz, Krystyna Sztefko, and Iwona Rogatko Copyright © 2014 Małgorzata Czogała et al. All rights reserved. Prevalence of Gene Rearrangements in Mexican Children with Acute Lymphoblastic Leukemia: A Population Study—Report from the Mexican Interinstitutional Group for the Identification of the Causes of Childhood Leukemia Thu, 17 Jul 2014 14:52:59 +0000 Mexico has one of the highest incidences of childhood leukemia worldwide and significantly higher mortality rates for this disease compared with other countries. One possible cause is the high prevalence of gene rearrangements associated with the etiology or with a poor prognosis of childhood acute lymphoblastic leukemia (ALL). The aims of this multicenter study were to determine the prevalence of the four most common gene rearrangements [ETV6-RUNX1, TCF3-PBX1, BCR-ABL1, and MLL rearrangements] and to explore their relationship with mortality rates during the first year of treatment in ALL children from Mexico City. Patients were recruited from eight public hospitals during 2010–2012. A total of 282 bone marrow samples were obtained at each child’s diagnosis for screening by conventional and multiplex reverse transcription polymerase chain reaction to determine the gene rearrangements. Gene rearrangements were detected in 50 (17.7%) patients. ETV6-RUNX1 was detected in 21 (7.4%) patients, TCF3-PBX1 in 20 (7.1%) patients, BCR-ABL1 in 5 (1.8%) patients, and MLL rearrangements in 4 (1.4%) patients. The earliest deaths occurred at months 1, 2, and 3 after diagnosis in patients with MLL, ETV6-RUNX1, and BCR-ABL1 gene rearrangements, respectively. Gene rearrangements could be related to the aggressiveness of leukemia observed in Mexican children. Vilma Carolina Bekker-Méndez, Enrique Miranda-Peralta, Juan Carlos Núñez-Enríquez, Irma Olarte-Carrillo, Francisco Xavier Guerra-Castillo, Ericka Nelly Pompa-Mera, Alicia Ocaña-Mondragón, Angélica Rangel-López, Roberto Bernáldez-Ríos, Aurora Medina-Sanson, Elva Jiménez-Hernández, Raquel Amador-Sánchez, José Gabriel Peñaloza-González, José de Diego Flores-Chapa, Arturo Fajardo-Gutiérrez, Janet Flores-Lujano, María del Carmen Rodríguez-Zepeda, Elisa María Dorantes-Acosta, Victoria Bolea-Murga, Nancy Núñez-Villegas, Martha Margarita Velázquez-Aviña, José Refugio Torres-Nava, Nancy Carolina Reyes-Zepeda, Cesar González-Bonilla, and Juan Manuel Mejía-Aranguré Copyright © 2014 Vilma Carolina Bekker-Méndez et al. All rights reserved. Estimates of the Number of People Living with HIV in Italy Thu, 17 Jul 2014 06:57:14 +0000 Objective. To estimate the HIV prevalence and the number of people living with HIV (PLHIV) in Italy with a projection for 2020. Methods. Two methods elaborated by Joint United Nations Programme on HIV/AIDS (UNAIDS) were used: Estimate and Projection Package and Spectrum. Results. A total of 123,000 (115,000–145,000) individuals aged 15 or more were estimated to be living with HIV in Italy at the end of 2012 and the estimated HIV prevalence was 0.28 (0.24–0.32) per 100 residents aged 15 or more. In 2012, the estimated number of new HIV infections among adults was 3,000 (2,700–4,000), and the number of adults in need for ART was 93,000 (80,000–110,000). The projection estimates that 130,000 (110,000–150,000) adults will live with HIV/AIDS in 2020 in Italy. Conclusion. Estimates of PLHIV in Italy stress the high number of PLHIV in need of care and treatment, as well as the need for more information and prevention campaigns. Laura Camoni, Vincenza Regine, Karen Stanecki, Maria Cristina Salfa, Mariangela Raimondo, and Barbara Suligoi Copyright © 2014 Laura Camoni et al. All rights reserved. Skin Cancer, Irradiation, and Sunspots: The Solar Cycle Effect Mon, 14 Jul 2014 07:52:25 +0000 Skin cancer is diagnosed in more than 2 million individuals annually in the United States. It is strongly associated with ultraviolet exposure, with melanoma risk doubling after five or more sunburns. Solar activity, characterized by features such as irradiance and sunspots, undergoes an 11-year solar cycle. This fingerprint frequency accounts for relatively small variation on Earth when compared to other uncorrelated time scales such as daily and seasonal cycles. Kolmogorov-Zurbenko filters, applied to the solar cycle and skin cancer data, separate the components of different time scales to detect weaker long term signals and investigate the relationships between long term trends. Analyses of crosscorrelations reveal epidemiologically consistent latencies between variables which can then be used for regression analysis to calculate a coefficient of influence. This method reveals that strong numerical associations, with correlations >0.5, exist between these small but distinct long term trends in the solar cycle and skin cancer. This improves modeling skin cancer trends on long time scales despite the stronger variation in other time scales and the destructive presence of noise. Edward Valachovic and Igor Zurbenko Copyright © 2014 Edward Valachovic and Igor Zurbenko. All rights reserved. Evidence for Association of the E23K Variant of KCNJ11 Gene with Type 2 Diabetes in Tunisian Population: Population-Based Study and Meta-Analysis Mon, 07 Jul 2014 09:41:16 +0000 Aims. Genetic association studies have reported the E23K variant of KCNJ11 gene to be associated with Type 2 diabetes. In Arab populations, only four studies have investigated the role of this variant. We aimed to replicate and validate the association between the E23K variant and Type 2 diabetes in Tunisian and Arab populations. Methods. We have performed a case-control association study including 250 Tunisian patients with Type 2 diabetes and 267 controls. Allelic association has also been evaluated by 2 meta-analyses including all population-based studies among Tunisians and Arabs (2 and 5 populations, resp.). Results. A significant association between the E23K variant and Type 2 diabetes was found (OR = 1.6, 95% CI = 1.14–2.27, and ). Furthermore, our meta-analysis has confirmed the significant role of the E23K variant in susceptibility of Type 2 diabetes in Tunisian and Arab populations (OR = 1.29, 95% CI = 1.15–1.46, and and OR = 1.33, 95% CI = 1.13–1.56, and , resp.). Conclusion. Both case-control and meta-analyses results revealed the significant association between the E23K variant of KCNJ11 and Type 2 diabetes among Tunisians and Arabs. Khaled Lasram, Nizar Ben Halim, Sana Hsouna, Rym Kefi, Imen Arfa, Welid Ghazouani, Henda Jamoussi, Houda Benrahma, Najla Kharrat, Ahmed Rebai, Slim Ben Ammar, Sonia Bahri, Abdelhamid Barakat, Abdelmajid Abid, and Sonia Abdelhak Copyright © 2014 Khaled Lasram et al. All rights reserved. Dynamics of the HIV Epidemic in MSM Sun, 29 Jun 2014 12:46:32 +0000 Yujiang Jia, Muktar H. Aliyu, and Z. Jennifer Huang Copyright © 2014 Yujiang Jia et al. All rights reserved. Global Epidemiology of Dementia: Alzheimer’s and Vascular Types Wed, 25 Jun 2014 11:02:55 +0000 The prevalence of dementia varies substantially worldwide. This is partially attributed to the lack of methodological uniformity among studies, including diagnostic criteria and different mean population ages. However, even after considering these potential sources of bias, differences in age-adjusted dementia prevalence still exist among regions of the world. In Latin America, the prevalence of dementia is higher than expected for its level of population aging. This phenomenon occurs due to the combination of low average educational attainment and high vascular risk profile. Among developed countries, Japan seems to have the lowest prevalence of dementia. Studies that evaluated the immigration effect of the Japanese and blacks to USA evidenced that acculturation increases the relative proportion of AD cases compared to VaD. In the Middle East and Africa, the number of dementia cases will be expressive by 2040. In general, low educational background and other socioeconomic factors have been associated with high risk of obesity, sedentarism, diabetes, hypertension, dyslipidemia, and metabolic syndrome, all of which also raise the risk of VaD and AD. Regulating these factors is critical to generate the commitment to make dementia a public health priority. Liara Rizzi, Idiane Rosset, and Matheus Roriz-Cruz Copyright © 2014 Liara Rizzi et al. All rights reserved. Nongenetic Determinants of Age at Menarche: A Systematic Review Mon, 23 Jun 2014 06:35:53 +0000 Background. The acceleration of pubertal development is an important medical and social problem, as it may result in increased morbidity and mortality in later life. This systematic review summarizes relevant data about nongenetic factors, which contribute to age at menarche (AAM), and suggests those which may be the most important. Methods. The available literature from 1980 till July 2013 was searched using PubMed and Google Scholar databases. Finally, 154 papers were selected for the analysis. Results. Environmental factors, which may affect AAM, vary in populations of different ethnicity. The prenatal, infancy, and early childhood periods are the most susceptible to these factors. Body weight, high animal protein intake, family stressors (e.g., single parenting), and physical activity seem to influence AAM in most populations. Conclusions. The data about influence of nongenetic factors on AAM are still inconsistent. The factors affecting prenatal and early childhood growth seem to have a larger effect on further sexual maturation. Further studies are needed in order to validate the association between other environmental determinants and AAM in different ethnical groups. Anna Yermachenko and Volodymyr Dvornyk Copyright © 2014 Anna Yermachenko and Volodymyr Dvornyk. All rights reserved. Allele Frequency of ABO Blood Group Antigen and the Risk of Esophageal Cancer Thu, 19 Jun 2014 13:30:43 +0000 Background. ABO blood group and risk of squamous cell carcinoma of esophagus have been reported by many studies, but there is no discipline that had provided association with the genotype and gene frequency by population statics. Methods. We conducted a case-control study on 480 patients with squamous cell carcinoma of the esophagus and 480 noncancer patients. ABO blood group was determined by presence of antigen with the help of monoclonal antibody. Chi-square test and odds ratio (OR) with 95% confidence intervals (CIs) were calculated by statistical methods, and gene frequencies were calculated by Hardy-Weinberg model. Results. We observed significant associations between ABO genotype and squamous cell carcinoma of esophagus. OR (95% CIs) was 1.69 (1.31–2.19) for presence of B antigen allele relative to its absence (); in female subgroup OR (95% CIs) observed at 1.84 (1.27–2.65) was statistically significant (). SCC of esophagus shows significant difference in comparison to general population; blood group B is found to be higher in incidence (). Increased risk of cancer was observed with absence of Rh antigen (). Relatively increased gene frequency of q[B] allele is observed more significantly in female cancer patients (). Conclusion. Statistically significant association between squamous cell carcinoma of the esophagus and ABO and Rh genotype is identified by this study. Sex and anatomical site of cancer also present with statistically significant relative association. However, larger randomised trials are required to establish the hypothesis. Narender Kumar, Akhil Kapoor, Ashok Kalwar, Satya Narayan, Mukesh Kumar Singhal, Akhender Kumar, Abhishek Mewara, and Megh Raj Bardia Copyright © 2014 Narender Kumar et al. All rights reserved. Prevalence and Risk Factors for Pterygium in Rural Older Adults in Shandong Province of China: A Cross-Sectional Study Thu, 12 Jun 2014 05:51:33 +0000 To investigate the prevalence and risk factors for pterygium in rural older adults in Shandong Province, eastern China, a population-based, cross-sectional study was performed from April to July 2008. By means of cluster random sampling methods, a total of 19,583 people aged 50 years or above were randomly selected from four rural counties. Out of 19,583 people, 1,767 residents were excluded mainly because they were migrant workers when this study was performed. Finally, 17,816 (90.98%) people were included as eligible subjects. They received a comprehensive eye examination and a structured questionnaire voluntarily. Patients with pterygium were defined as having pterygium at the time of survey or pterygium surgery had been performed. 1,876 people were diagnosed as pterygium, either unilateral (1,083) or bilateral (793), which is equivalent to a prevalence of 10.53% (95% CI, 10.08–10.98). The multivariate logistic regression analysis showed that pterygium was independently associated with older age, areas, outdoor time, educational level, and use of hat and/or sunglasses. The prevalence of pterygium increased with age and hours spent under sunshine per day. Meanwhile, the higher the educational level and the more use of hat and/or sunglasses, the lower the pterygium prevalence. Wanzhen Jiao, Chengchao Zhou, Ting Wang, Shaoyuan Yang, Hongsheng Bi, Liping Liu, Yan Li, and Lihua Wang Copyright © 2014 Wanzhen Jiao et al. All rights reserved. Ovarian Cancer Screening Practices of Obstetricians and Gynecologists in Puerto Rico Thu, 05 Jun 2014 12:38:45 +0000 Background. Ovarian cancer is the most fatal malignancy of the female genital tract and is associated with high mortality. The American Congress of Obstetricians and Gynecologists (ACOG) and the United States Preventive Services Task Force (USPSTF) recommend against screening for ovarian cancer in asymptomatic, average-risk women. Objective. To assess the ovarian cancer screening practices in asymptomatic, average-risk women among obstetricians and gynecologists (Ob/Gyn) in Puerto Rico. Methodology. From 2011 to 2012, self-administered anonymous questionnaires were mailed to all licensed obstetricians and gynecologists in PR. Results. Response rate was 25%. Overall, 53.9% were screening for the disease. Reported screening methods were CA-125 and transvaginal ultrasound (TVUS), 39.2%, TVUS only, 30.4%, and CA-125 only, 9.8%. In the logistic regression model, the odds that a given health practitioner routinely screened for ovarian cancer in the asymptomatic, average-risk population increased by 8% with every unit increase in his or her years in practice. Conclusion. The majority of the practicing Ob/Gyn in PR who participated are not following the guidelines established by the ACOG and the USPSTF for ovarian cancer screening. Gianni Rodríguez-Ayala, Josefina Romaguera, Mariel López, and Ana P. Ortiz Copyright © 2014 Gianni Rodríguez-Ayala et al. All rights reserved. Serum Lipids, Apolipoproteins, and Mortality among Coronary Artery Disease Patients Thu, 29 May 2014 16:17:40 +0000 The proatherogenic effect of low-density lipoprotein cholesterol (LDL-C) and antiatherogenic effect of high-density lipoprotein cholesterol (HDL-C) have been confirmed in general population. But controversy arises among coronary artery disease (CAD) patients. The goal of this study was to identify the association of different lipid measurements with CAD prognosis. The study cohort included 1916 CAD patients who were 40–85 years of age. Cox proportional hazards regression models were used to estimate the association of baseline 6 lipid factors and 3 ratios with all-cause and cardiovascular (CVD) mortality. During a median follow-up of 3.1 years, 147 deaths were recorded, 113 of which were due to CVD. When lipid factors were categorized, HDL-C showed a U-shape association with all-cause and CVD mortality after adjustment for major CVD risk factors. Serum LDL-C, apoB, LDL/HDL ratio, and apoB/apoA-I ratio were positively, and apoA-I level was inversely associated with the risk of CVD mortality. After further pairwise comparison of lipid-related risk, LDL/HDL ratio and LDL-C had stronger association with all-cause and CVD mortality than other proatherogenic measurements among Chinese CAD patients. Ding Ding, Xinrui Li, Jian Qiu, Rui Li, Yuan Zhang, Dongfang Su, Zhongxia Li, Min Wang, Xiaofei Lv, Dongliang Wang, Yan Yang, Min Xia, Dan Li, Gang Hu, and Wenhua Ling Copyright © 2014 Ding Ding et al. All rights reserved. Risks of Decreased Renal Function and Increased Albuminuria for Glycemic Status and Metabolic Syndrome Components: Taichung Community Health Study Mon, 12 May 2014 09:28:17 +0000 Background. The objective of this study was to assess the association of glycemic status and decreased renal function as determined by estimated glomerular filtration rate (eGFR) and albuminuria in an adult Taiwanese metropolitan population. Methods. We did a cross-sectional survey in a representative sample of 2,350 Taiwanese adults aged 40 years and over living in a metropolitan city in Taiwan from 2004 to 2005. Glycemic status was classified as normal glycemia, hyperglycemia, and type 2 diabetes (T2D). Renal function was assessed with eGFR using modified Modification of Diet in Renal Disease Study equation for Chinese. Albuminuria was determined by the urinary albumin-creatinine ratio. Decreased renal function was defined as eGFR <60 mL/min/1.73 m2 and albuminuria as the albumin-creatinine ratio >30 mg g−1 creatinine. Results. 593 (25.23%) had hyperglycemia and 287 (12.21%) had T2D. As glycemia level increased, the prevalence of albuminuria and decreased eGFR increased. After adjustment, T2D was associated with an OR of 2.93 (95% CI: 2.11–4.07) for albuminuria, and an OR of 2.05 (95% CI: 1.18–3.58) for decreased eGFR. Conclusions. In a representative sample from a metropolitan city in Taiwan, T2D was associated with albuminuria and decreased eGFR. Cheng-Chieh Lin, Chia-Ing Li, Chiu-Shong Liu, Wen-Yuan Lin, Chih-Hsueh Lin, Ming-May Lai, Yih-Dar Lee, Ching-Chu Chen, Chuan-Wei Yang, and Tsai-Chung Li Copyright © 2014 Cheng-Chieh Lin et al. All rights reserved. Prenatal Maternal Stress Predicts Childhood Asthma in Girls: Project Ice Storm Thu, 08 May 2014 12:46:29 +0000 Little is known about how prenatal maternal stress (PNMS) influences risks of asthma in humans. In this small study, we sought to determine whether disaster-related PNMS would predict asthma risk in children. In June 1998, we assessed severity of objective hardship and subjective distress in women pregnant during the January 1998 Quebec Ice Storm. Lifetime asthma symptoms, diagnoses, and corticosteroid utilization were assessed when the children were 12 years old (). No effects of objective hardship or timing of the exposure were found. However, we found that, in girls only, higher levels of prenatal maternal subjective distress predicted greater lifetime risk of wheezing (; 90% CI = 1.01–1.23), doctor-diagnosed asthma (; 90% CI = 1.00–1.19), and lifetime utilization of corticosteroids (; 90% CI = 1.01–1.25). Other perinatal and current maternal life events were also associated with asthma outcomes. Findings suggest that stress during pregnancy opens a window for fetal programming of immune functioning. A sex-based approach may be useful to examine how prenatal and postnatal environments combine to program the immune system. This small study needs to be replicated with a larger, more representative sample. Anne-Marie Turcotte-Tremblay, Robert Lim, David P. Laplante, Lester Kobzik, Alain Brunet, and Suzanne King Copyright © 2014 Anne-Marie Turcotte-Tremblay et al. All rights reserved. Epidemiology of Injuries in Belgium: Contribution of Hospital Data for Surveillance Mon, 28 Apr 2014 09:55:26 +0000 Objectives. Investigating injuries in terms of occurrences and patient and hospital stay characteristics. Methods. 17370 stays, with at least one E code, were investigated based on data from 13 Belgian hospitals. Pearson’s chi-square and Kruskal-Wallis tests were used to assess the variations between distributions of the investigated factors according to the injury’s types. Results. Major injuries were accidental falls, transport injuries, and self-inflicted injuries. There were more men in the transport injuries group and the accidental falls group was older. For the transport injuries, there were more arrivals with the support of a mobile intensive care unit and/or a paramedic intervention team and a general practitioner was more implicated for the accidental falls. In three-quarters of cases, it was a primary diagnostic related to injury and poisoning which was made. The median length of stay was nearly equal to one week and for accidental falls, this value is three times higher. The median cost, from the social security point of view, for all injuries was equal to €1377 and there was a higher median cost within the falls group. Conclusion. This study based on hospitals data provides important information both on factors associated with and on hospital costs generated by injuries. Christelle Senterre, Alain Levêque, Lionel Di Pierdomenico, Michèle Dramaix-Wilmet, and Magali Pirson Copyright © 2014 Christelle Senterre et al. All rights reserved. Clusters of Adolescent and Young Adult Thyroid Cancer in Florida Counties Mon, 28 Apr 2014 06:59:02 +0000 Background. Thyroid cancer is a common cancer in adolescents and young adults ranking 4th in frequency. Thyroid cancer has captured the interest of epidemiologists because of its strong association to environmental factors. The goal of this study is to identify thyroid cancer clusters in Florida for the period 2000–2008. This will guide further discovery of potential risk factors within areas of the cluster compared to areas not in cluster. Methods. Thyroid cancer cases for ages 15–39 were obtained from the Florida Cancer Data System. Next, using the purely spatial Poisson analysis function in SaTScan, the geographic distribution of thyroid cancer cases by county was assessed for clusters. The reference population was obtained from the Census Bureau 2010, which enabled controlling for population age, sex, and race. Results. Two statistically significant clusters of thyroid cancer clusters were found in Florida: one in southern Florida (SF) (relative risk of 1.26; value of <0.001) and the other in northwestern Florida (NWF) (relative risk of 1.71; value of 0.012). These clusters persisted after controlling for demographics including sex, age, race. Conclusion. In summary, we found evidence of thyroid cancer clustering in South Florida and North West Florida for adolescents and young adult. Raid Amin and James J. Burns Copyright © 2014 Raid Amin and James J. Burns. All rights reserved. Prevalence of HIV and Syphilis Infection among Men Who Have Sex with Men in China: A Meta-Analysis Wed, 23 Apr 2014 13:43:03 +0000 Objectives. To figure out the most current prevalence of HIV and syphilis in MSM in China. Methods. A meta-analysis was conducted on the studies searched through PubMed, CNKI, and Wanfang published between 1 January 2009 and 11 April 2013. Results. Eighty-four eligible studies, either in Chinese or in English, were included in this review. The pooled prevalence of HIV and syphilis infection in MSM in China was 6.5% and 11.2%, respectively. The subgroup analyses indicated that the prevalence of HIV infection was higher in the economically less developed cities than that in the developed cities (7.5% versus 6.1%, ). In contrast, the prevalence of syphilis infection was lower in less developed cities than in developed cities (8.6% versus 15.1%). Studies with a sample size smaller than 500 had a lower prevalence of HIV and syphilis infection than those with a sample size greater than 500 (5.9% versus 7.2% for HIV; 11.0% versus 11.5% for syphilis, respectively). Conclusions. HIV and syphilis infection are prevalent in MSM in China. The different prevalence of HIV and syphilis infection between developing and developed cities underscores the need to target prevention strategies based on economic conditions. Yunhua Zhou, Dongliang Li, Dabing Lu, Yuhua Ruan, Xiao Qi, and Ge Gao Copyright © 2014 Yunhua Zhou et al. All rights reserved. rs744166 Polymorphism of the STAT3 Gene Is Associated with Risk of Gastric Cancer in a Chinese Population Wed, 23 Apr 2014 07:33:33 +0000 The aim of this study was to explore the association between polymorphisms in signal transducer and activator of transcription protein 3 (STAT3) and the risk of gastric cancer. In the present study, a case-control study was conducted in which rs2293152 and rs744166 polymorphisms in STAT3 were analyzed in 209 Chinese patients with gastric cancer and 294 cancer-free controls. The genotypes were determined by polymerase chain reaction restriction fragment length polymorphism method. For the rs744166 polymorphism, the TC genotype (adjusted , 95% CI = 0.39–0.92, and ) and CC genotype (adjusted , 95% , and ) were associated with a decreased risk of gastric cancer compared to the TT genotype. However, rs2293152 did not show any difference in gastric cancer risk between patients and controls in the CG/CC genotype compared to the GG genotype. Besides, the SNP effects were additive to the effects of environmental factors without any interaction between them in the susceptibility to gastric cancer. Collectively, rs744166 polymorphism might be significantly associated with a decreased risk of gastric cancer in a Chinese population. Additionally, polymorphisms in STAT3, along with environmental factors, might be associated with the development of gastric cancer. Kexin Yuan, Huimin Liu, Lina Huang, Xiyun Ren, Jingjing Liu, Xiaoqun Dong, Wenjing Tian, and Yunhe Jia Copyright © 2014 Kexin Yuan et al. All rights reserved. HIV Prevalence Trends, Risky Behaviours, and Governmental and Community Responses to the Epidemic among Men Who Have Sex with Men in China Mon, 14 Apr 2014 00:00:00 +0000 Purpose of Review. Numerous studies reported the rapid spread of HIV/AIDS epidemic among men who have sex with men (MSM) in China. This paper aims to investigate the overall epidemic trend and associated high-risk behaviours among Chinese MSM and to explore the governmental and community responses to the epidemic. Recent Findings. HIV prevalence among Chinese MSM increased rapidly in all Chinese regions in the past decade and disproportionally affected the Southwest China. In addition to the high-risk homosexual behaviours, overlapping bisexual, commercial, and drug use behaviours are commonly observed among Chinese MSM. The Chinese government has significantly expanded the surveillance efforts among MSM over the past decade. Community responses against HIV have been substantially strengthened with the support of international aid. However, lack of enabling legal and financial environment undermines the role of community-based organisations (CBOs) in HIV surveillance and prevention. Conclusion. HIV continues to spread rapidly among MSM in China. The hidden nature of MSM and the overlapping homosexual, bisexual, and commercial behaviours remain a challenge for HIV prevention among MSM. Strong collaboration between the government and CBOs and innovative intervention approaches are essential for effective HIV surveillance and prevention among MSM in China. Eric P. F. Chow, Joseph T. F. Lau, Xun Zhuang, Xiaohu Zhang, Yanjie Wang, and Lei Zhang Copyright © 2014 Eric P. F. Chow et al. All rights reserved. Beyond Obesity and Lifestyle: A Review of 21st Century Chronic Disease Determinants Mon, 07 Apr 2014 13:59:16 +0000 The obesity epidemic and associated chronic diseases are often attributed to modern lifestyles. The term “lifestyle” however, ignores broader social, economic, and environmental determinants while inadvertently “blaming the victim.” Seen more eclectically, lifestyle encompasses distal, medial, and proximal determinants. Hence any analysis of causality should include all these levels. The term “anthropogens,” or “…man-made environments, their by-products and/or lifestyles encouraged by these, some of which may be detrimental to human health” provides a monocausal focus for chronic diseases similar to that which the germ theory afforded infectious diseases. Anthropogens have in common an ability to induce a form of chronic, low-level systemic inflammation (“metaflammation”). A review of anthropogens, based on inducers with a metaflammatory association, is conducted here, together with the evidence for each in connection with a number of chronic diseases. This suggests a broader view of lifestyle and a focus on determinants, rather than obesity and lifestyle per se as the specific causes of modern chronic disease. Under such an analysis, obesity is seen more as “a canary in a mineshaft” signaling problems in the broader environment, suggesting that population obesity management should be focused more upstream if chronic diseases are to be better managed. Garry Egger and John Dixon Copyright © 2014 Garry Egger and John Dixon. All rights reserved. Menopause and Metabolic Syndrome in Tunisian Women Mon, 31 Mar 2014 14:14:39 +0000 Objectives. This study aimed to evaluate the effect of menopausal status on the risk of metabolic syndrome (MetS) in Tunisian women. Methods. We analyzed a total of 2680 women aged between 35 and 70 years. Blood pressure, anthropometric indices, fasting glucose, and lipid profile were measured. The MetS was assessed by the modified NCEP-ATPIII definition. Results. The mean values of waist circumference, blood pressure, plasma lipids, and fasting glucose were significantly higher in postmenopausal than in premenopausal women, a difference that was no longer present when adjusting for age. Except for hypertriglyceridaemia, the frequency of central obesity, hyperglycemia, high blood pressure, and high total cholesterol was significantly higher in postmenopausal than in premenopausal women. After adjusting for age, the significance persisted only for hyperglycemia. The overall prevalence of MetS was 35.9%, higher in postmenopausal (45.7% versus 25.6%) than in premenopausal women. A binary logistic regression analysis showed that menopause was independently associated with MetS (OR = 1.41, 95% CI 1.10–1.82) after adjusting for age, residence area, marital status, family history of cardiovascular disease, education level, and occupation. Conclusions. The present study provides evidence that the MetS is highly prevalent in this group of women. Menopause can be a predictor of MetS independent of age in Tunisian women. Samir Ben Ali, Hanen Belfki-Benali, Hajer Aounallah-Skhiri, Pierre Traissac, Bernard Maire, Francis Delpeuch, Noureddine Achour, and Habiba Ben Romdhane Copyright © 2014 Samir Ben Ali et al. All rights reserved. Risk Factors for HIV/Syphilis Infection and Male Circumcision Practices and Preferences among Men Who Have Sex with Men in China Sun, 30 Mar 2014 08:25:39 +0000 Objective. To investigate factors associated with HIV infection and the frequency and willingness of male circumcision among men who have sex with men (MSM) in Chengdu city, China. Methods. A cross-sectional survey provided information on participants' demographics, risk behaviors, circumcision, and uptake of HIV prevention services. Results. Of 570 participants, 13.3% were infected with HIV and 15.9% with syphilis. An estimated 43.0% of respondents reported having unprotected receptive anal intercourse, and 58.9% reported having ≥2 male sexual partners in the past 6 months. Multivariable logistic regression revealed that syphilis, more male sex partners, predominantly receptive anal intercourse, and exclusively receptive male sex were associated with HIV infection. Higher level of education and peer education service were inversely associated with HIV infection. Nearly a fifth (18.0%) of participants were circumcised. More than half of uncircumcised participants expressed willingness to be circumcised. Conclusion. This study reveals a high prevalence of HIV and syphilis among MSM in Chengdu province of China. The frequency of unprotected receptive anal intercourse and multiple male sexual partnerships highlight the urgency for an effective comprehensive HIV prevention strategy. Although the willingness to accept male circumcision (MC) is high, further research is needed to assess the protective effective of MC among MSM. Yali Zeng, Linglin Zhang, Tian Li, Wenhong Lai, Yujiang Jia, Muktar H. Aliyu, Mai Do, Xiaodong Wang, Delin Han, Wanli Huang, Shuping Du, Jie Xu, Jiushun Zhou, Shu Liang, Fei Yu, and Yanqing Zhang Copyright © 2014 Yali Zeng et al. All rights reserved. HIV Risk Perception among HIV Negative or Status-Unknown Men Who Have Sex with Men in China Sun, 30 Mar 2014 07:13:01 +0000 Objective. To evaluate HIV risk perception and its associated factors among Chinese MSM. Methods. A cross-sectional study was conducted among MSM with an HIV negative or unknown status in Beijing, China, between 2011 and 2012. A questionnaire interview was conducted and a blood sample was collected for HIV and syphilis testing. Results. Of 887 MSM who reported they were HIV negative or did not know their HIV status before recruitment, only 7.3% reported a high risk of HIV infection, 28.0% medium risk, 52.2% low risk, and 12.5% no risk. In multivariate logistic regression models using those who reported a medium self-perceived risk as a reference group, self-reported high risk of HIV perception was associated with minority ethnicity (odds ratio [OR]: 2.91; 95% confidence interval [CI]: 1.03–8.19), self-reported history of sexually transmitted diseases (OR: 2.27; 95% CI: 1.25–4.10), and HIV testing times since the last HIV testing (OR: 0.47; 95% CI: 0.26–0.84); low self-perceived risk of HIV infection was related to full-time employment (OR: 1.58; 95% CI: 1.15–2.18) and illicit drug use (OR: 0.28; 95% CI: 0.10–0.75). Conclusions. The HIV/AIDS epidemic is rapidly rising among Beijing MSM, but more than half MSM did not perceive this risk. Wensheng Fan, Lu Yin, Han-Zhu Qian, Dongliang Li, Yiming Shao, Sten H. Vermund, Yuhua Ruan, and Zheng Zhang Copyright © 2014 Wensheng Fan et al. All rights reserved. Nitrite Inhalants Use and HIV Infection among Men Who Have Sex with Men in China Thu, 27 Mar 2014 16:10:55 +0000 Objective. This is the first study in China to examine the use of nitrite inhalants and its correlates among men who have sex with men (MSM) in Beijing, China. Methods. A cross-sectional survey was conducted in 2012. Structured interviews collected data on demographics, sexual and drug use behaviors, and the use of HIV services. Blood specimens were collected and tested for HIV and syphilis. Results. A total of 400 MSM eligible for the study were between 19 and 63 years of age and overall HIV prevalence was 6.0% (9.0% among nitrite inhalant users and 3.3% among nonusers). Nearly half (47.3%) of them reported ever using nitrite inhalants and 42.3% admitted using nitrite inhalants in the past year. Multivariable logistic analysis revealed that ever using nitrite inhalants in the past was independently associated with being aged years, having higher education attainment, seeking sex via Internet, having casual partners in the past three months, and being HIV positive. Conclusion. The use of nitrite inhalants was alarmingly prevalent among MSM in Beijing. The independent association of the nitrite inhalant use with more casual sex partners and HIV infection underscored the need for intervention and prevention of nitrite inhalant use. Dongliang Li, Xueying Yang, Zheng Zhang, Xiao Qi, Yuhua Ruan, Yujiang Jia, Stephen W. Pan, Dong Xiao, Z. Jennifer Huang, Fengji Luo, and Yifei Hu Copyright © 2014 Dongliang Li et al. All rights reserved. Alcohol Use, Stigmatizing/Discriminatory Attitudes, and HIV High-Risk Sexual Behaviors among Men Who Have Sex with Men in China Thu, 27 Mar 2014 12:06:33 +0000 Objective. This research was conducted to assess the correlates of alcohol consumption and HIV/AIDS-related stigmatizing and discriminatory attitudes among men who have sex with men (MSM) in Shandong province, China. Methods. A cross-sectional survey provided demographics, sexual behaviors, illicit drug use, alcohol consumptions, and service utilization. Results. Of 1,230 participants, 82.8% were single, 85.7% aged <35 years, 47.2% had college or higher education, and 11.7% drank alcohol >3 times per week in the past six months. The average total score of stigmatizing and discriminatory attitude was 37.4 ± 4.4. More frequent episodes of alcohol use were independently associated with higher levels of HIV/AIDS-related stigma and discrimination, unprotected anal sex, bisexual identity, multiple male sex partners, drug use, and lower levels of education. Expressing higher levels of HIV/AIDS-related stigmatizing and discriminatory attitudes was independently associated with alcohol use, unprotected male anal sex, bisexuals, more male sex partners, commercial sex with men, and non-receipt of peer education in the past year. Conclusion. HIV/AIDS-related stigmatizing and discriminatory attitudes are common and associated with alcohol use and unprotected sex among MSM. The finding highlights the needs to develop programs that would reduce HIV/AIDS-related stigmatizing and discriminatory attitudes and strengthen alcohol use prevention and risk reduction initiatives among MSM. Meizhen Liao, Dianmin Kang, Xiaorun Tao, Jennifer Huang Bouey, Muktar H. Aliyu, Yuesheng Qian, Guoyong Wang, Xiaoguang Sun, Bin Lin, Zhenqiang Bi, and Yujiang Jia Copyright © 2014 Meizhen Liao et al. All rights reserved. HIV Prevention Services and Testing Utilization Behaviors among Men Who Have Sex with Men at Elevated Risk for HIV in Chongqing, China Wed, 26 Mar 2014 00:00:00 +0000 Objective. To investigate barriers and correlates of the use of HIV prevention services and HIV testing behaviors among men who have sex with men in Chongqing. Methods. Three consecutive cross-sectional surveys provided demographic, sexual behavior, HIV/syphilis infection, HIV prevention service, and testing behavior data. Results. Of 1239 participants, 15.4% were infected with HIV, incidence was 12.3 per 100 persons/year (95% CI: 9.2–15.3), 38% of the participants reported ever having unprotected insertive anal sex, 40% ever received free condom/lubricants in the past year, and 27.7% ever obtained free sexually transmitted infection examination/treatment in the past year. Multivariable logistic regression revealed that lower levels of HIV/AIDS related stigmatizing/discriminatory attitudes, full-time jobs, and sex debut with men at a younger age were independently associated with use of free condom/lubricants. Large social networks, higher incomes, and sexual debut with men at a younger age were associated with use of any HIV prevention and HIV testing services. Lower levels of stigmatizing/discriminatory attitudes were also associated with HIV testing. Fearing needles and being unaware of the venues for testing were top barriers for testing service utilization. Conclusion. It is imperative to address HIV/AIDS related stigmatizing/discriminatory attitudes and other barriers while delivering intervention and testing services. Dayong Huang, Yifei Hu, Guohui Wu, Yujiang Jia, Rongrong Lu, Yan Xiao, H. F. Raymond, Willi McFarland, Yuhua Ruan, Wei Ma, and Jiangping Sun Copyright © 2014 Dayong Huang et al. All rights reserved. The Dynamic Trends of HIV Prevalence, Risks, and Prevention among Men Who Have Sex with Men in Chongqing, China Tue, 25 Mar 2014 09:18:17 +0000 Objective. This study was to characterize the continuously changing trends of HIV prevalence, risks, sexual behaviors, and testing behaviors among men who have sex with men (MSM) in Chongqing, China. Methods. Five consecutive cross-sectional surveys were conducted among MSM in 2006, 2008, 2010, 2012, and 2013. Testing for HIV and syphilis was performed, and HIV risks, sexual behavior, prevention, and HIV testing behavior were collected using the same questionnaire. Results. HIV prevalence increased from 13.0% to 19.7% from 2006 to 2013 (), with an increase of 1.0% per year. Syphilis prevalence peaked in 2008 with a positive rate of 11.6% and then experienced a sharp drop to 2.8% in 2012 and 2.9% in 2013. Percentage of those who ever received HIV testing in the last year increased from 17.0% to 43.3% (); condom use at the last anal intercourse and reported consistent condom use in the last 6 months increased from 51.8% to 71.0% () and from 24.7% to 47.9% (), respectively. Conclusions. HIV continued to spread among MSM in Chongqing even when a decline in prevalence of syphilis and increase in awareness rate, condom use, and HIV testing seeking behaviors seemed to occur. Gang Zeng, Liangui Feng, Lin Ouyang, Rongrong Lu, Peng Xu, Guohui Wu, and Fan Lu Copyright © 2014 Gang Zeng et al. All rights reserved. Alcohol Consumption during Adolescence and Risk of Diabetes in Young Adulthood Mon, 17 Mar 2014 12:38:45 +0000 Background. There is very limited data available on the association between underage drinking and risk of diabetes. The aim of this study is to investigate the association between alcohol use during adolescence and the risk of diabetes while controlling for a wide range of confounders, including parental alcohol use. Methods. This population-based study used data collected from the National Longitudinal Study of Adolescent Health (Add Health). Participants were initially recruited in 1994-1995 (Wave I), then followed up in 1996 (Wave II) and in 2001-2002 (Wave III), and in 2008-2009 (Wave IV). Analysis included 2,850 participants (46% male) who were successfully followed up at Waves I, III, and IV without a known diagnosis of diabetes at Waves I and III and who provided all necessary information for the analysis. Results. During adolescence, frequent alcohol consumption at levels reaching 5 or more drinks, 3–7 days/week, substantially increased the risk of diabetes in young adulthood, with an odds ratio of 12.57 (95% CI 4.10–38.61) compared to current abstainers. Conclusions. Heavy alcohol use during adolescence may increase the risk of diabetes in young adulthood. The Significant finding of the Study. Wenbin Liang and Tanya Chikritzhs Copyright © 2014 Wenbin Liang and Tanya Chikritzhs. All rights reserved. Alcohol Use among Chinese Men Who Have Sex with Men: An Epidemiological Survey and Meta-Analysis Tue, 11 Mar 2014 06:46:26 +0000 The HIV/AIDS epidemic among Chinese men who have sex with men (MSM) has become a significant public health concern. Knowledge of alcohol consumption in this population is limited. In this study, 1,155 Chinese MSM were surveyed to assess alcohol use and its correlates. A meta-analysis was also performed to aggregate pooled prevalence of current alcohol use. MSM who were unmarried (aOR: 1.87; 95% CI: 1.29–2.71) or unemployed/retired (aOR: 2.77; 95% CI: 1.73–4.45) were more likely to drink alcohol more than once per week. MSM who consumed alcohol more than once per week were more likely to use drug , have sex with women , have unprotected insertive or receptive anal sex with men, have more than 10 lifetime male sex partners , predominantly practice insertive anal sex , and trade sex for money . Pooled overall alcohol use prevalence was 32%. Pooled prevalence for MSM who drank alcohol more than once per week and who drank alcohol before sex with male partners was 23%. Our findings provide the basis for further exploring the alcohol-HIV association and developing risk reduction interventions. Yu Liu, Han-Zhu Qian, Yuhua Ruan, Lu Yin, Juntao Ma, Kapil Dahiya, Wensheng Fan, Yiming Shao, and Sten H. Vermund Copyright © 2014 Yu Liu et al. All rights reserved. Associations between Cognitive, Sociocontextual, and Affective Variables and Unprotected Anal Intercourse among Men Who Have Sex with Men—A Comparative Study Conducted in Two Chinese Cities Wed, 05 Mar 2014 07:37:04 +0000 Few studies compared HIV-related risk behaviors between cities with different sociocultural environments among men who have sex with men (MSM). This study investigated the prevalence of unprotected anal intercourse (UAI) and associated individual and socio-cultural factors among Chinese MSM in Hong Kong and Shenzhen in Mainland China, which were proximal to each other but experienced different socioeconomic developments. Amongst all the 535 participants, 40.2% had had UAI. Significant factors of UAI among Shenzhen MSM included being able to find someone to share one’s sexual orientation, disclosure of sexual orientation to family members, HIV risk perception, and use of alcohol or substances (adjusted OR ranged from 2.37 to 4.91), whilst disclosure of sexual orientation to family members was the only significant factor among Hong Kong MSM (adjusted OR = 1.64). Geographic variations in factors associated with UAI were observed. Future research and interventions need to take this into account. Joseph T. F. Lau, T. J. Feng, X. L. Liu, Jing Gu, Hi Yi Tsui, F. C. Hong, Zixin Wang, and Wangnan Cao Copyright © 2014 Joseph T. F. Lau et al. All rights reserved. Social and Behavioral Risk Marker Clustering Associated with Biological Risk Factors for Coronary Heart Disease: NHANES 2001–2004 Tue, 25 Feb 2014 13:24:17 +0000 Background. Social and behavioral risk markers (e.g., physical activity, diet, smoking, and socioeconomic position) cluster; however, little is known whether clustering is associated with coronary heart disease (CHD) risk. Objectives were to determine if sociobehavioral clustering is associated with biological CHD risk factors (total cholesterol, HDL cholesterol, systolic blood pressure, body mass index, waist circumference, and diabetes) and whether associations are independent of individual clustering components. Methods. Participants included 4,305 males and 4,673 females aged ≥20 years from NHANES 2001–2004. Sociobehavioral Risk Marker Index (SRI) included a summary score of physical activity, fruit/vegetable consumption, smoking, and educational attainment. Regression analyses evaluated associations of SRI with aforementioned biological CHD risk factors. Receiver operator curve analyses assessed independent predictive ability of SRI. Results. Healthful clustering (SRI = 0) was associated with improved biological CHD risk factor levels in 5 of 6 risk factors in females and 2 of 6 risk factors in males. Adding SRI to models containing age, race, and individual SRI components did not improve C-statistics. Conclusions. Findings suggest that healthful sociobehavioral risk marker clustering is associated with favorable CHD risk factor levels, particularly in females. These findings should inform social ecological interventions that consider health impacts of addressing social and behavioral risk factors. Nicholas J. Everage, Crystal D. Linkletter, Annie Gjelsvik, Stephen T. McGarvey, and Eric B. Loucks Copyright © 2014 Nicholas J. Everage et al. All rights reserved. Rattus norvegicus (Rodentia: Muridae) Infected by Leishmania (Leishmania) infantum (syn. Le. chagasi) in Brazil Sun, 23 Feb 2014 00:00:00 +0000 In the present study we surveyed the fauna of phlebotomine sand flies and small mammals in peridomestic areas from a Brazilian municipality where the American cutaneous leishmaniasis (ACL) is endemic. A total of 608 female phlebotomine sand flies were captured during nine months in 2009 and 2010. Seven different species were represented with 60% of them being Lutzomyia intermedia and Lu. whitmani, both incriminated vectors of ACL. Lu. longipalpis, a proven vector of visceral leishmaniasis (VL) was also captured at high proportion (12.8%). Genomic DNA analysis of 136 species-specific pools of female sand flies followed by molecular genotyping showed the presence of Leishmania infantum DNA in two pools of Lu. longipalpis. The same Leishmania species was found in one blood sample from Rattus norvegicus among 119 blood and tissue samples analysed. This is the first report of Le. infantum in R. norvegicus in the Americas and suggests a possible role for this rodent species in the zoonotic cycle of VL. Our study coincided with the reemergence of VL in Governador Valadares. Fabiana de Oliveira Lara-Silva, Ricardo Andrade Barata, Érika Monteiro Michalsky, Eduardo de Castro Ferreira, Maria Olímpia Garcia Lopes, Aimara da Costa Pinheiro, Consuelo Latorre Fortes-Dias, and Edelberto Santos Dias Copyright © 2014 Fabiana de Oliveira Lara-Silva et al. All rights reserved. A Proxy Outcome Approach for Causal Effect in Observational Studies: A Simulation Study Tue, 18 Feb 2014 16:30:18 +0000 Background. Known and unknown/unmeasured risk factors are the main sources of confounding effects in observational studies and can lead to false observations of elevated protective or hazardous effects. In this study, we investigate an alternative approach of analysis that is operated on field-specific knowledge rather than pure statistical assumptions. Method. The proposed approach introduces a proxy outcome into the estimation system. A proxy outcome possesses the following characteristics: (i) the exposure of interest is not a cause for the proxy outcome; (ii) causes of the proxy outcome and the study outcome are subsets of a collection of correlated variables. Based on these two conditions, the confounding-effect-driven association between the exposure and proxy outcome can then be measured and used as a proxy estimate for the effects of unknown/unmeasured confounders on the outcome of interest. Performance of this approach is tested by a simulation study, whereby 500 different scenarios are generated, with the causal factors of a proxy outcome and a study outcome being partly overlapped under low-to-moderate correlations. Results. The simulation results demonstrate that the conventional approach only led to a correct conclusion in 21% of the 500 scenarios, as compared to 72.2% for the alternative approach. Conclusion. The proposed method can be applied in observational studies in social science and health research that evaluates the health impact of behaviour and mental health problems. Wenbin Liang, Yuejen Zhao, and Andy H. Lee Copyright © 2014 Wenbin Liang et al. All rights reserved. An Investigation of the Significance of Residual Confounding Effect Mon, 17 Feb 2014 12:18:32 +0000 Background. Observational studies are commonly conducted in health research. However, due to their lack of randomization, the estimated associations between the outcome and the exposure can be affected by unmeasured confounding factors. It is important to determine how likely a significant association observed between an outcome variable and a noncausally related exposure may be introduced by residual confounding factors. Methods. A simulation approach is developed based on the sufficient cause model to test the likelihood of significant associations observed between a noncausally related exposure and the outcome. Results. Based on the estimates from all 500 replicates, the association between the exposure and the outcome is found to be significant in 386 (77%) replicates when all confounders (component causes) are controlled for in the model. However, when a subset of real component causes and some noncausal factors are controlled for in the model, the association between exposure and the outcome becomes significant in 487 (97%) replicates. Conclusion. Even when all confounding factors are known and controlled for using conventional multivariate analysis, the observed association between exposure and outcome can still be dominated by residual confounding effects. Therefore, an observed significant association apparently provides limited evidence for a causal relationship. Wenbin Liang, Yuejen Zhao, and Andy H. Lee Copyright © 2014 Wenbin Liang et al. All rights reserved. Changing the Landscape of the HIV Epidemic among MSM in China: Results from Three Consecutive Respondent-Driven Sampling Surveys from 2009 to 2011 Mon, 20 Jan 2014 09:25:02 +0000 This study assessed the changes of HIV incidence and its predictors among Beijing’s men who have sex with men (MSM). Three consecutive cross-sectional surveys were carried out using a consistent respondent-driven sampling (RDS) approach in 2009, 2010, and 2011, respectively. Structured-questionnaire based interviews were completed with computer-assisted self-administration. Incident infection was examined with BED capture enzyme immunoassay (BED-CEIA). The overall rate of HIV prevalence was 8.0% in the three years (95% confidence interval [CI]: 4.9%–11.2%). The overall rate of BED-CEIA incidence was 7.8/100 person years (PY) (95% CI: 5.5–10.1) with 6.8/100PY (95% CI: 3.4–10.2) in 2009, 11.2/100PY (95% CI: 6.2–16.3) in 2010, and 5.8/100PY (95% CI: 2.4–9.3) in 2011, respectively. Multivariable logistic regression analysis revealed that, compared with HIV-negative MSM, recently infected MSM were more likely to be bisexual (adjusted odds ratio [AOR] = 2.1, 95% CI: 1.1–4.1), live in Beijing ≤3 years (AOR = 2.1, 95% CI: 1.2–4.0), and have a negative attitude towards safe sex (AOR = 1.1 per scale point, 95% CI: 1.0–1.1). This study demonstrated a disturbing rise of HIV infections among Beijing’s MSM. These findings underscored the urgency of scaling up effective and better-targeted intervention services to stop the rapid spread of the virus. Xuefeng Li, Hongyan Lu, Catherine Cox, Yuejuan Zhao, Dongyan Xia, Yanming Sun, Xiong He, Yan Xiao, Yuhua Ruan, Yujiang Jia, and Yiming Shao Copyright © 2014 Xuefeng Li et al. All rights reserved. Dental Calculus Is Associated with Death from Heart Infarction Thu, 09 Jan 2014 14:19:37 +0000 Objectives. We studied whether the amount of dental calculus is associated with death from heart infarction in the dental infection—atherosclerosis paradigm. Materials. Participants were 1676 healthy young Swedes followed up from 1985 to 2011. At the beginning of the study all subjects underwent oral clinical examination including dental calculus registration scored with calculus index (CI). Outcome measure was cause of death classified according to WHO International Classification of Diseases. Unpaired t-test, Chi-square tests, and multiple logistic regressions were used. Results. Of the 1676 participants, 2.8% had died during follow-up. Women died at a mean age of 61.5 years and men at 61.7 years. The difference in the CI index score between the survivors versus deceased patients was significant by the year 2009 (). In multiple regression analysis of the relationship between death from heart infarction as a dependent variable and CI as independent variable with controlling for age, gender, dental visits, dental plaque, periodontal pockets, education, income, socioeconomic status, and pack-years of smoking, CI score appeared to be associated with 2.3 times the odds ratio for cardiac death. Conclusions. The results confirmed our study hypothesis by showing that dental calculus indeed associated statistically with cardiac death due to infarction. Birgitta Söder, Jukka H. Meurman, and Per-Östen Söder Copyright © 2014 Birgitta Söder et al. All rights reserved. Age at First Use of Alcohol and Risk of Heavy Alcohol Use: A Population-Based Study Sun, 29 Dec 2013 08:49:58 +0000 Aim. To examine the association between age at first alcohol use and risk of heavy alcohol use among the adult US general drinking population. Methods. This population-based study used the 2010 National Survey on Drug Use and Health (NSDUH) from United States. Multivariate Poisson regression was employed to predict the frequency of heavy alcohol use (five or more drinks per occasion) in the last 30 days with age at first use of alcohol controlling for potential confounding factors. Results. Younger age at first use of alcohol was associated with increased likelihood of heavy alcohol use in the last 30 days in this population-based sample. This association remained significant when analysis was reperformed for the subgroup of participants who were with desired good health status and Kessler score lower than 12. Conclusion. Younger age at first use of alcohol was associated with increased likelihood of heavy alcohol use. Wenbin Liang and Tanya Chikritzhs Copyright © 2013 Wenbin Liang and Tanya Chikritzhs. All rights reserved. Clinical Epidemiology of Reduced Kidney Function among Elderly Male Fishing and Agricultural Population in Taipei, Taiwan Wed, 13 Nov 2013 15:45:54 +0000 Purpose. To quantify the prevalence of and associated factors for chronic kidney disease (CKD) among male elderly fishing and agricultural population in Taipei, Taiwan. Methods. Subjects () aged 65 years and over voluntarily admitted to a teaching hospital for a physical checkup were collected in 2010. CKD was defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2. Results. Among these subjects, the over prevalence of chronic kidney disease was 13.6% (95% CI: 12.3–14.9%). The age-specific prevalence of CKD in 65–74 years, 75–84 years, and ≥85 years was 8.2%, 19.1%, and 27.0%, respectively. From the multiple logistic regression, age (OR = 1.05, 95% CI: 1.02–1.09), hyperuricemia (OR = 2.94, 95% CI: 1.90–3.78), central obesity (OR = 1.17, 95% CI: 1.02–1.56), hyperglycemia (OR = 1.23, 95% CI: 1.11–1.67), hypertriglyceridemia (OR = 1.25, 95% CI: 1.08–1.66), and lower HDL-C (OR = 1.61, 95% CI: 1.23–1.92) were statistically significantly related to CKD. The presence of metabolic components (one or two versus none, OR = 1.10, 95% CI: 1.04–1.25; three or more versus none, OR = 2.12, 95% CI: 1.86–2.78) also appeared to be statistically significantly related to CKD after adjustment for other independent factors. Conclusion. Several clinical factors independently affect the development of CKD in the elderly male fishing and agricultural population. Chi-Mei Kuo, Wu-Hsiung Chien, Hsi-Che Shen, Yi-Chun Hu, Yu-Fen Chen, and Tao-Hsin Tung Copyright © 2013 Chi-Mei Kuo et al. All rights reserved. Traumatic Brain Injury Related Hospitalization and Mortality in California Wed, 13 Nov 2013 10:35:18 +0000 Objective. The aim of this study is to describe the traumatic brain injury (TBI) population and causes and identify factors associated with TBI hospitalizations and mortality in California. Methods. This is a cross-sectional study of 61,188 patients with TBI from the California Hospital Discharge Data 2001 to 2009. We used descriptive, bivariate, and multivariate analyses in SAS version 9.3. Results. TBI-related hospitalizations decreased by 14% and mortality increased by 19% from 2001 to 2009. The highest percentages of TBI hospitalizations were due to other causes (38.4%), falls (31.2%), being of age years old (37.2%), being a males (58.9%), and being of Medicare patients (44%). TBIs due to falls were found in those age years old (53.5%), years old (44.0%), and females (37.2%). TBIs due to assaults were more frequent in Blacks (29.0%). TBIs due to motor vehicle accidents were more frequent in 15–19 and 20–24 age groups (48.7% and 48.6%, resp.) and among Hispanics (27.8%). Higher odds of mortality were found among motor vehicle accident category (adjusted odds ratio (AOR): 1.27, 95% CI: 1.14–1.41); males (AOR: 1.36, 95% CI: 1.27–1.46); and the -year-old group (AOR: 6.4, 95% CI: 4.9–8.4). Conclusions. Our findings suggest a decrease in TBI-related hospitalizations but an increase in TBI-related mortality during the study period. The majority of TBI-related hospitalizations was due to other causes and falls and was more frequent in the older, male, and Medicare populations. The higher likelihood of TBI-related mortalities was found among elderly male years old who had motor vehicle accidents. Our data can inform practitioners, prevention planners, educators, service sectors, and policy makers who aim to reduce the burden of TBI in the community. Implications for interventions are discussed. Clint Lagbas, Shahrzad Bazargan-Hejazi, Magda Shaheen, Dulcie Kermah, and Deyu Pan Copyright © 2013 Clint Lagbas et al. All rights reserved. Epidemiology and Risk Factors of Tooth Loss among Iranian Adults: Findings from a Large Community-Based Study Mon, 21 Oct 2013 08:27:46 +0000 Objectives. To investigate the prevalence of tooth loss and different prosthetic rehabilitations among Iranian adults, as well as the potential determinants of tooth loss. Methods. In a cross-sectional community-based study conducted among 8094 Iranian adults living in Isfahan province, a self-administered questionnaire was used to assess epidemiologic features of tooth loss. Results. Thirty-two percent of subjects had all their teeth, 58.6% had lost less than 6, and 7.2% of participants had lost more than 6 teeth. One hundred and sixty-nine individuals (2.2%) were edentulous. Among participants, 2.3% had single jaw removable partial denture, 3.6% had complete removable denture in both jaws, and 4.6% had fixed prosthesis. Others reported no prosthetic rehabilitation (89.5%). In the age subgroup analysis (≤35 and >35 years old) tooth loss was more prevalent among men than women ( and 1.9, resp., ). Also, in both age groups, current and former smokers had higher levels of tooth loss than nonsmokers ( and , resp.). In addition, tooth loss was positively related to metabolic abnormality for age group >35 years (adjusted , ). Conclusions. Tooth loss is highly prevalent in Iranian adult population. Community programs promoting oral health for prevention of tooth loss should be considered taking into account its major determinants including lower educational level, male gender, smoking, and metabolic abnormality. Saber Khazaei, A. H. Keshteli, Awat Feizi, Omid Savabi, and Peyman Adibi Copyright © 2013 Saber Khazaei et al. All rights reserved. Content of Trans Fatty Acids in Human Cheek Epithelium: Comparison with Serum and Adipose Tissue Tue, 08 Oct 2013 16:10:45 +0000 Studies pertaining to trans fatty acids (TFA), which have been implicated in development of chronic diseases, are more relevant in developing countries where nutrition transition is changing traditional habits and practices. Measuring TFA is an arduous task because of the need for fat biopsies. This study identifies a tissue, which can be easily accessed for analytical measurement of trans fatty acid. In this cross-sectional study, fatty acid in adipose tissue, cheek epithelium, and blood samples were assessed by gas chromatography. Spearman correlation coefficient was computed to study the correlation of fatty acid distribution among the three tissues. The correlation coefficient of total trans fatty acid between cheek epithelium and serum was 0.30 () and between cheek epithelium and adipose tissue was 0.33 (). This study is the first to report trans fatty acid profile in cheek epithelium giving scope for utilizing the cheek epithelium as a tissue for objective assessment of trans fatty acid intake. Ransi A. Abraham, Vinay K. Bahl, Rajinder Parshad, V. Seenu, Ambuj Roy, Smita Golandaz, Prabhakaran Dorairaj, and Lakshmy Ramakrishnan Copyright © 2013 Ransi A. Abraham et al. All rights reserved. Application of Zero-Inflated Poisson Mixed Models in Prognostic Factors of Hepatitis C Tue, 01 Oct 2013 10:13:47 +0000 Background and Objectives. In recent years, hepatitis C virus (HCV) infection represents a major public health problem. Evaluation of risk factors is one of the solutions which help protect people from the infection. This study aims to employ zero-inflated Poisson mixed models to evaluate prognostic factors of hepatitis C. Methods. The data was collected from a longitudinal study during 2005–2010. First, mixed Poisson regression (PR) model was fitted to the data. Then, a mixed zero-inflated Poisson model was fitted with compound Poisson random effects. For evaluating the performance of the proposed mixed model, standard errors of estimators were compared. Results. The results obtained from mixed PR showed that genotype 3 and treatment protocol were statistically significant. Results of zero-inflated Poisson mixed model showed that age, sex, genotypes 2 and 3, the treatment protocol, and having risk factors had significant effects on viral load of HCV patients. Of these two models, the estimators of zero-inflated Poisson mixed model had the minimum standard errors. Conclusions. The results showed that a mixed zero-inflated Poisson model was the almost best fit. The proposed model can capture serial dependence, additional overdispersion, and excess zeros in the longitudinal count data. Alireza Akbarzadeh Baghban, Asma Pourhoseingholi, Farid Zayeri, Ali Akbar Jafari, and Seyed Moayed Alavian Copyright © 2013 Alireza Akbarzadeh Baghban et al. All rights reserved. Age-Related Differences in the Effect of Psychological Distress on Mortality: Type D Personality in Younger versus Older Patients with Cardiac Arrhythmias Wed, 25 Sep 2013 17:51:55 +0000 Background. Mixed findings in biobehavioral research on heart disease may partly be attributed to age-related differences in the prognostic value of psychological distress. This study sought to test the hypothesis that Type D (distressed) personality contributes to an increased mortality risk following implantable cardioverter defibrillator (ICD) treatment in younger patients but not in older patients. Methods. The Type D Scale (DS14) was used to assess general psychological distress in 455 younger (≤70 y,. Cardiac resynchronization therapy (CRT), but not Type D personality, was associated with increased mortality in older patients. Among younger patients, however, Type D personality was associated with an adjusted hazard ratio = 1.91 (95% CI 1.09–3.34) and 2.26 (95% CI 1.16–4.41) for all-cause and cardiac mortality; other predictors were increasing age, CRT, appropriate shocks, ACE-inhibitors, and smoking. Conclusion. Type D personality was independently associated with all-cause and cardiac mortality in younger ICD patients but not in older patients. Cardiovascular research needs to further explore age-related differences in psychosocial risk. Johan Denollet, Fetene B. Tekle, Pepijn H. van der Voort, Marco Alings, and Krista C. van den Broek Copyright © 2013 Johan Denollet et al. All rights reserved. JIS Definition Identified More Malaysian Adults with Metabolic Syndrome Compared to the NCEP-ATP III and IDF Criteria Mon, 23 Sep 2013 14:10:08 +0000 Metabolic syndrome (MetS) is a steering force for the cardiovascular diseases epidemic in Asia. This study aimed to compare the prevalence of MetS in Malaysian adults using NCEP-ATP III, IDF, and JIS definitions, identify the demographic factors associated with MetS, and determine the level of agreement between these definitions. The analytic sample consisted of 8,836 adults aged ≥30 years recruited at baseline in 2007–2011 from the Cardiovascular Risk Prevention Study (CRisPS), an ongoing, prospective cohort study involving 18 urban and 22 rural communities in Malaysia. JIS definition gave the highest overall prevalence (43.4%) compared to NCEP-ATP III (26.5%) and IDF (37.4%), . Indians had significantly higher age-adjusted prevalence compared to other ethnic groups across all MetS definitions (30.1% by NCEP-ATP III, 50.8% by IDF, and 56.5% by JIS). The likelihood of having MetS amongst the rural and urban populations was similar across all definitions. A high level of agreement between the IDF and JIS was observed (Kappa index = 0.867), while there was a lower level of agreement between the IDF and NCEP-ATP III (Kappa index = 0.580). JIS definition identified more Malaysian adults with MetS and therefore should be recommended as the preferred diagnostic criterion. Anis Safura Ramli, Aqil Mohammad Daher, Mohamed Noor Khan Nor-Ashikin, Nafiza Mat-Nasir, Kien Keat Ng, Maizatullifah Miskan, Krishnapillai S. Ambigga, Farnaza Ariffin, Md Yasin Mazapuspavina, Suraya Abdul-Razak, Hasidah Abdul-Hamid, Fadhlina Abd-Majid, Najmin Abu-Bakar, Hapizah Nawawi, and Khalid Yusoff Copyright © 2013 Anis Safura Ramli et al. All rights reserved. Outbreak of Hepatitis A in a Nursery School Thu, 19 Sep 2013 11:16:41 +0000 In a background of very low incidence of hepatitis A HA in the last decade (annual average of 1.8 cases per 100,000 inhabitants) we describe an outbreak of HA which evolved in Mallorca between May and August 2010, whose main focus was a nursery school where more cases were parents and other young relatives of the children of the institution. Thirty-four cases were defined as outbreak cases. Ten were children of the nursery or their siblings and 22 adults (3 staff members of the nursery and 19 relatives; median age 33 years). The first detected cases were children of the same class. There were 2 adults with haematological complications, though not severe. All children, nursery staff members, parents, and siblings of the cases of the first affected class were immediately offered HA vaccination, but only 43.3% eligible individuals accepted it. None of the cases had been vaccinated. The outbreak spread mostly from asymptomatic children to young adults, showing the changes in HA pattern. That is of great concern as the risk of severe illness rises with age. This incident shows the need to implement new HA vaccination policies in outbreak control. This was later carried out. Antonia Galmes-Truyols, Jaume Gimenez-Duran, Antonio Nicolau-Riutort, Catalina Bosch-Isabel, Juana Maria Vanrell-Berga, and Margarita Portell-Arbona Copyright © 2013 Antonia Galmes-Truyols et al. All rights reserved. Association of Urban Slum Residency with Infant Mortality and Child Stunting in Low and Middle Income Countries Tue, 17 Sep 2013 13:38:33 +0000 This study aimed to (i) examine the contextual influences of urban slum residency on infant mortality and child stunting over and above individual and household characteristics and (ii) identify factors that might modify any adverse effects. We obtained data from Demographic and Health Surveys conducted in 45 countries between 2000 and 2009. The respondents were women (15–49 years) and their children (0–59 months). Results showed that living in a slum neighborhood was associated with infant mortality (OR = 1.34, 95% CI = 1.15–1.57) irrespective of individual and household characteristics and this risk was attenuated among children born to women who had received antenatal care from a health professional (OR = 0.79, 95% CI = 0.63–0.99). Results also indicated that increasing child age exacerbated the risk for stunting associated with slum residency (OR = 1.19, 95% CI = 1.16–1.23). The findings suggest that improving material circumstances in urban slums at the neighborhood level as well as increasing antenatal care coverage among women living in these neighborhoods could help reduce infant mortality and stunted child growth. The cumulative impact of long-term exposure to slum neighborhoods on child stunting should be corroborated by future studies. Hmwe Hmwe Kyu, Harry S. Shannon, Katholiki Georgiades, and Michael H. Boyle Copyright © 2013 Hmwe Hmwe Kyu et al. All rights reserved. The Investigation of Tramadol Dependence with No History of Substance Abuse: A Cross-Sectional Survey of Spontaneously Reported Cases in Guangzhou City, China Thu, 12 Sep 2013 09:10:17 +0000 The study was to survey and assess the drug dependence and abuse potential of tramadol with no history of substance abuse. Subjects of tramadol dependence with no prior history of substance abuse were surveyed by interview. Physical dependence of tramadol was assessed using 10 items opiate withdrawal scale (OWS), and psychological dependence was assessed by Addiction Research Center Inventory—Chinese Version (ARCI-CV). Twenty-three male subjects (the median age was years) referred to the addiction unit in Medical Hospital of Guangzhou with tramadol abuse problems were included in this cross-sectional study. The control group included 87 heroin addicts, 60 methamphetamine (MA) abusers, and 50 healthy men. The scores of OWS of tramadol were 0.83–2.30; the mean scores of identifying euphoric effects–MBG, sedative effects–PCAG, and psychotomimetic effects–LSD of ARCI were , , and , respectively, F = 4.927, . Scores of MBG scale in tramadol did not differ from those in heroin and MA groups () but were higher than those in healthy men (). Tramadol with no history of substance abuse has a clear risk of producing high abuse potential under the long-term infrequent abuse and the high doses. Haoran Zhang and Zhimin Liu Copyright © 2013 Haoran Zhang and Zhimin Liu. All rights reserved. Creation of an Adiposity Index for Children Aged 6–8 Years: The Gateshead Millennium Study Sun, 08 Sep 2013 11:30:57 +0000 Objective. A number of measures of childhood adiposity are in use, but all are relatively imprecise and prone to bias. We constructed an adiposity index (AI) using a number of different measures. Methods. Detailed body composition data on 460 of the Gateshead Millennium Study cohort at the age of 6–8 years were analysed. The AI was calculated using factor analysis on age plus thirteen measures of adiposity and/or size. Correlations between these variables, the AI, and more traditional measures of adiposity in children were investigated. Results. Based on the factor loading sizes, the first component, taken to be the AI, consisted mainly of measures of fat-mass (the skinfold measurements, fat mass score, and waist circumference). The second comprised variables measuring frame size, while the third consisted mainly of age. The AI had a high correlation with body mass index (BMI) (rho = 0.81). Conclusions. While BMI is practical for assessing adiposity in children, the AI combines a wider range of data related to adiposity than BMI alone and appears both valid and valuable as a research tool for studies of childhood adiposity. Further research is necessary to investigate the utility of AI for research in other samples of children and also in adults. Mark S. Pearce, Peter W. James, Maria Franco-Villoria, Kathryn N. Parkinson, Angela R. Jones, Laura Basterfield, Robert F. Drewett, Charlotte M. Wright, and Ashley J. Adamson Copyright © 2013 Mark S. Pearce et al. All rights reserved. Prevalence of Chronic Headache in Croatia Sun, 01 Sep 2013 08:09:38 +0000 Background. Chronic headache describes the presence of headache for >15 days per month on average for >3 months and fulfills the rest of the IHS criteria. The prevalence of chronic headache is within the range of 0.5–7.3% worldwide. The aim of this study was to determine the 1-year prevalence of chronic headache in adult Croatian population. Methods. The data were collected from a cross-sectional survey of an adult population (>18 years of age) sample. Randomly selected patients from the general population in four Croatian cities were asked to fulfill a self-completed questionnaire. The prevalence of chronic headache was calculated in the sample representing 3 383 769 Croatian adults. Results. The total sample included 1542 responders among which 616 were with headache. The 1-year prevalence of chronic headache was 2.4%, and 0.9% of responders declared having headache 30 days per month. According to these results, 81 192 adult inhabitants in Croatia suffer from chronic headache. Conclusions. The prevalence of chronic headache in Croatia is comparable to other countries worldwide. These patients require special attention and should be offered multidisciplinary medical support. Vlasta Vuković-Cvetković, Davor Plavec, and Arijana Lovrenčić-Huzjan Copyright © 2013 Vlasta Vuković-Cvetković et al. All rights reserved. Codetection of Trichomonas vaginalis and Candida albicans by PCR in Urine Samples in a Low-Risk Population Attended in a Clinic First Level in Central Veracruz, Mexico Thu, 29 Aug 2013 15:41:09 +0000 The aim of this study is to estimate the prevalence of Trichomonas vaginalis and Candida albicans in low-risk patients treated at a first level clinic (primary health care represents the first level of contact of individuals, families, and the community with the system national health). Using a cross-sectional study in patients treated in clinical laboratory of the Sanitary District no. 7 of the city of Orizaba during the months June-July, 252 urine samples were collected for the identification of T. vaginalis and C. albicans by PCR. Furthermore, we analyzed the sociodemographic characteristics of the studied population. We observed an overall prevalence of 23.41% (95% CI 22.10–24.72) for T. vaginalis and 38.88% (95% CI 37.73–40.03) for C. albicans. There was also presence of coinfection in 14.28% (95% CI 13.10–15.46), which was associated with the presence of pain. Most of the positive cases were observed in women house-maker (80%, 95% CI 50.36–48.98). The results of this study provide evidence that the majority of positive cases observed in the studied population are presented in an asymptomatic form and usually are not associated with any risk factor. A. López-Monteon, F. S. Gómez-Figueroa, G. Ramos-Poceros, D. Guzmán-Gómez, and A. Ramos-Ligonio Copyright © 2013 A. López-Monteon et al. All rights reserved. The Clinical Profile and Prognosis of Chinese Children with Melamine-Induced Kidney Disease: A Systematic Review and Meta-Analysis Wed, 07 Aug 2013 13:33:01 +0000 Introduction. Studies have reported inconsistent results regarding clinical feature and the prognosis status of the affected children in China melamine-contamination event. We summarized available literatures by performing a review and meta-analysis. Methods. Statistical pooling was performed using random-effects model; the sources of heterogeneity were explored through subgroup analyses. Results. Twenty-six studies involving 2164 patients with kidney abnormalities were identified; 94.4% of the patients had urinary calculi and 95.8% of the calculi were <10 mm in diameter. Of 2040 patients with known types of treatment, 5.6% underwent surgical treatment. The pooled recovery rates at 1, 3, 6, and 12 months after diagnosis or treatment initiation were 67.1%, 76.3%, 85.4%, and 92.3%, respectively; these pooled rates did not differ between the study subgroups stratified by mean age at diagnosis, mean duration of melamine exposure, types of patients (inpatient/outpatient), and treatment types (specific/nonspecific), except that the 1-month recovery rate for studies involving a specific treatment (71.9%) was higher than that for studies involving non-specific treatment (46.2%). Conclusion. The majority of patients had small calculi and could recover without surgical treatment. Kidney abnormalities remained in about 8% of the patients at 12-month followup, indicating a need for longer-term followup. Pei-Xin Wang, Hong-Tian Li, Long Zhang, and Jian-Meng Liu Copyright © 2013 Pei-Xin Wang et al. All rights reserved. High Genetic Diversity of Enterococcus faecium and Enterococcus faecalis Clinical Isolates by Pulsed-Field Gel Electrophoresis and Multilocus Sequence Typing from a Hospital in Malaysia Wed, 29 May 2013 15:18:04 +0000 Little is known on the genetic relatedness and potential dissemination of particular enterococcal clones in Malaysia. We studied the antibiotic susceptibility profiles of Enterococcus faecium and Enterococcus faecalis and subjected them to pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). E. faecium and E. faecalis displayed 27 and 30 pulsotypes, respectively, and 10 representative E. faecium and E. faecalis isolates (five each) yielded few different sequence types (STs): ST17 (2 isolates), ST78, ST203, and ST601 for E. faecium, and ST6, ST16, ST28, ST179, and ST399 for E. faecalis. Resistance to tazobactam-piperacillin and ampicillin amongst E. faecium isolates was highly observed as compared to E. faecalis isolates. All of the isolates were sensitive to vancomycin and teicoplanin. The presence of epidemic and nosocomial strains of selected E. faecium STs: 17, 78, and 203 and E. faecalis ST6 as well as high rates of resistance to multiple antibiotics amongst E. faecium isolates is of a particular concern. Poh Leng Weng, Ramliza Ramli, Mariana Nor Shamsudin, Yoke-Kqueen Cheah, and Rukman Awang Hamat Copyright © 2013 Poh Leng Weng et al. All rights reserved.