BioMed Research International: Epidemiology The latest articles from Hindawi © 2017 , Hindawi Limited . All rights reserved. Prevalence and Risk Factors of Asthma, Rhinitis, and Eczema and Their Multimorbidity among Young Adults in Kuwait: A Cross-Sectional Study Wed, 30 Aug 2017 09:32:32 +0000 Objective. To estimate the prevalence of allergic diseases and allergic multimorbidity (coexistence) among young adults in Kuwait and to examine associations between risk factors with allergic diseases and allergic multimorbidity. Methods. A cross-sectional study was conducted by enrolling 1,154 students, aged 18–26 years, attending Kuwait University. Participants self-completed a questionnaire on symptoms and clinical history of allergic diseases. Prevalence ratios (PRs) and 95% confidence intervals (CIs) were estimated by applying Poisson regression with robust variance estimation. Results. The prevalence of current asthma, rhinitis, and eczema was estimated to be 11.9% (135/1135), 20.4% (232/1138), and 9.2% (105/1143), respectively. The coexistence of “asthma and rhinitis” (5.1%, 57/1125) was the most frequent allergic multimorbidity. Both maternal history (PR = 3.97, 95% CI: 2.32–6.80) and paternal history (PR = 1.72, 95% CI: 1.10–2.68) of allergy were independently associated with having two or more coexisting allergic diseases. The joint effect of having both maternal and paternal history of allergy was associated with 8.16 times (95% CI: 4.19–15.90) higher risk of allergic multimorbidity. Conclusion. Allergic diseases and allergic multimorbidity are common among young adults in Kuwait and their burden mirrors that of westernized countries. Parental history of allergy is a strong predisposing factor for allergic multimorbidity. Ali H. Ziyab Copyright © 2017 Ali H. Ziyab. All rights reserved. Nonpaternity and Half-Siblingships as Objective Measures of Extramarital Sex: Mathematical Modeling and Simulations Tue, 22 Aug 2017 00:00:00 +0000 Background. Understanding the epidemiology of HIV and other sexually transmitted infections (STIs) requires knowledge of sexual behavior, but self-reported behavior has limitations. We explored the reliability and validity of nonpaternity and half-siblings ratios as biomarkers of current and past extramarital sex. Methods. An individual-based Monte Carlo simulation model was constructed to describe partnering and conception in human populations with a focus on Sub-Saharan Africa (SSA). The model was parameterized with representative biological, behavioral, and demographic data. Results. Nonpaternity and half-siblings ratios were strongly correlated with extramarital sex, with Pearson correlation coefficients (PCC) of 0.79 (95% CI: 0.71–0.86) and 0.77 (0.68–0.84), respectively. Age-specific nonpaternity ratios correlated with past extramarital sex at time of conception for different scenarios: for example, PCC, after smoothing by moving averages, was 0.75 (0.52–0.89) in a scenario of steadily decreasing nonmarital sex and 0.39 (0.01–0.73) in a scenario of transient drops in nonmarital sex. Simulations assuming self-reported levels of extramarital sex from Kenya yielded nonpaternity levels lower than global nonpaternity data, suggesting sizable underreporting of extramarital sex. Conclusions. Nonpaternity and half-siblings ratios are useful objective measures of extramarital sex that avoid limitations in self-reported sexual behavior. Ryosuke Omori, Nico Nagelkerke, and Laith J. Abu-Raddad Copyright © 2017 Ryosuke Omori et al. All rights reserved. Exercise for Health and Disease: Time to Move Ahead Mon, 21 Aug 2017 00:00:00 +0000 Paulo Gentil, Fabrício Boscolo Del Vecchio, and James Steele Copyright © 2017 Paulo Gentil et al. All rights reserved. Corrigendum to “Molecular Epidemiological Investigation of Porcine kobuvirus and Its Coinfection Rate with PEDV and SaV in Northwest China” Thu, 17 Aug 2017 00:00:00 +0000 Chen Wang, Xi Lan, and Bin Yang Copyright © 2017 Chen Wang et al. All rights reserved. Candidemia in the Neonatal Intensive Care Unit: A Retrospective, Observational Survey and Analysis of Literature Data Sun, 13 Aug 2017 07:01:54 +0000 We evaluated the epidemiology of Candida bloodstream infections in the neonatal intensive care unit (NICU) of an Italian university hospital during a 9-year period as a means of quantifying the burden of infection and identifying emerging trends. Clinical data were searched for in the microbiological laboratory database. For comparative purposes, we performed a review of NICU candidemia. Forty-one candidemia cases were reviewed (overall incidence, 3.0 per 100 admissions). Candida parapsilosis sensu stricto (58.5%) and C. albicans (34.1%) were the most common species recovered. A variable drift through years was observed; in 2015, 75% of the cases were caused by non-albicans species. The duration of NICU hospitalization of patients with non-albicans was significantly longer than in those with C. albicans (median days, 10 versus 12). Patients with non-albicans species were more likely to have parenteral nutrition than those with C. albicans (96.3% versus 71.4%). Candida albicans was the dominant species in Europe and America (median, 55% and 60%; resp.); non-albicans species predominate in Asia (75%). Significant geographic variation is evident among cases of candidemia in different parts of the world, recognizing the importance of epidemiological data to facilitate the treatment. Giuseppina Caggiano, Grazia Lovero, Osvalda De Giglio, Giovanna Barbuti, Osvaldo Montagna, Nicola Laforgia, and Maria Teresa Montagna Copyright © 2017 Giuseppina Caggiano et al. All rights reserved. Intelligent Physical Exercise Training in a Workplace Setting Improves Muscle Strength and Musculoskeletal Pain: A Randomized Controlled Trial Mon, 07 Aug 2017 00:00:00 +0000 Purpose. To assess effects of 1-year Intelligent Physical Exercise Training (IPET) on musculoskeletal health. Methods. Office workers were randomized 1 : 1 to a training group, TG (), or a control group, CG (). TG received 1 h supervised high intensity IPET every week within working hours for 1 year and was recommended to perform 30 min of moderate intensity physical activity for 6 days a week during leisure. The IPET program was based on baseline health measures. Results. No baseline differences were present. An intention-to-treat analysis showed significant between-group effect for muscle strength but not for musculoskeletal pain. However, a per-protocol analysis of those with an adherence of ≥70% demonstrated a significant between-group effect for neck pain during the past three months. Several significant within-group changes were present, where TG and TG ≥ 70% demonstrated clinically relevant pain reductions whereas minimal reductions were seen for CG. Conclusion. IPET and recommendations of moderate intensity physical activity demonstrated significant between-group effect on muscle strength. Interestingly, significant within-group reductions in musculoskeletal pain were seen not only in TG but also in CG. This may underlie the lack of such between-group effect and shows that a possible positive side effect of merely drawing attention can improve musculoskeletal health. Tina Dalager, Just Bendix Justesen, and Gisela Sjøgaard Copyright © 2017 Tina Dalager et al. All rights reserved. Chronic Effects of Resistance Training in Breast Cancer Survivors Tue, 01 Aug 2017 07:30:41 +0000 Objective. To analyse effects of resistance training (RT) in breast cancer survivors (BCS) and how protocols and acute variables were manipulated. Methods. Search was made at PubMed, Science Direct, and LILACS. All articles published between 2000 and 2016 were considered. Studies that met the following criteria were included: written in English, Spanish, or Portuguese; BCS who have undergone surgery, chemotherapy, and/or radiotherapy; additional RT only; analysis of muscle performance, body mass composition (BMC), psychosocial parameters, or blood biomarkers. Results. Ten studies were included. PEDro score ranged from 5 to 9. Rest interval and cadence were not reported. Two studies reported continuous training supervision. All reported improvements in muscle strength, most with low or moderate effect size (ES), but studies performed with high loads presented large ES. Five described no increased risk or exacerbation of lymphedema. Most studies that analysed BMC showed no relevant changes. Conclusions. RT has been shown to be safe for BCS, with no increased risk of lymphedema. The findings indicated that RT is efficient in increasing muscle strength; however, only one study observed significant changes in BMC. An exercise program should therefore consider the manipulation of acute and chronic variables of RT to obtain optimal results. Wanderson Divino Nilo dos Santos, Paulo Gentil, Rafael Felipe de Moraes, João Batista Ferreira Júnior, Mário Hebling Campos, Claudio Andre Barbosa de Lira, Ruffo Freitas Júnior, Martim Bottaro, and Carlos Alexandre Vieira Copyright © 2017 Wanderson Divino Nilo dos Santos et al. All rights reserved. Prevalence and Molecular Characterization of Second-Line Drugs Resistance among Multidrug-Resistant Mycobacterium tuberculosis Isolates in Southwest of China Mon, 17 Jul 2017 08:17:58 +0000 This study aimed to investigate the prevalence of multidrug-resistant tuberculosis (MDR-TB) isolates resistant to the second-line antituberculosis drugs (SLDs) and its association with resistant-related gene mutations in Mycobacterium tuberculosis (M.tb) isolates from Southwest of China. There were 81 isolates resistant to at least one of the SLDs among 156 MDR-TB isolates (81/156, 51.9%). The rates of general resistance to each of the drugs were as follows: OFX (66/156, 42.3%), KAN (26/156, 16.7%), CAP (13/156, 8.3%), PTO (11/156, 7.1%), PAS (22/156, 14.1%), and AMK (20/156, 12.8%). Therefore, the most predominant pattern was resistant to OFX compared with other SLDs (). The results of sequencing showed that 80.2% OFX-resistant MDR-TB isolates contained gyrA mutation and 88.5% KAN-resistant isolates had rrs mutations with the most frequent mutation being A1401G. These results suggest that improper use of SLDs especially OFX is a real threat to effective MDR-TB treatment not only in China but also in the whole world. Furthermore the tuberculosis control agencies should carry out SLDs susceptibility testing and rapid screening in a broader population of TB patients immediately and the SLDs should be strictly regulated by the administration in order to maintain their efficacy to treat MDR-TB. Y. Hu, L. Xu, Y. L. He, Y. Pang, N. Lu, J. Liu, J. Shen, D. M. Zhu, X. Feng, Y. W. Wang, and C. Yang Copyright © 2017 Y. Hu et al. All rights reserved. Real World Evidence: A Quantitative and Qualitative Glance at Participant Feedback from a Free-Response Survey Investigating Experiences of a Structured Exercise Intervention for Men with Prostate Cancer Mon, 03 Jul 2017 00:00:00 +0000 Aim. To explore patient experiences of a structured exercise intervention for men with prostate cancer (PCa). Sample. 41 men with either localised or advanced PCa who had been referred for a structured exercise programme by their physician and then subsequently consented to a telephone survey. Method. Participants underwent a 10-week supervised exercise programme within a large cancer centre hospital consisting of 8 sessions. They then completed a short multiple choice telephone survey, elaborating on their responses where appropriate. Views expressed by participants were analysed using an affinity diagram and common themes were identified. Results. Feedback from our telephone surveys was consistently positive and suggests that the structured exercise intervention provides exercise confidence, motivation to exercise, and social support and promotes positive health behaviour change in the context of exercise. Individual differences arose amongst participants in their perceived utility of the intervention, with 73.3% expressing a preference for structured exercise classes and 19.5% expressing a preference for exercising independently. Conclusion. Design of a structured exercise intervention for patients with PCa should embrace the positive aspects outlined here but consider patients’ individual differences. Ongoing feedback from patients should be utilised alongside traditional study designs to inform intervention design in this area. L. Fox, F. Cahill, C. Burgess, N. Peat, S. Rudman, J. Kinsella, D. Cahill, G. George, A. Santaolalla, and M. Van Hemelrijck Copyright © 2017 L. Fox et al. All rights reserved. The Effect of Small Sample Size on Measurement Equivalence of Psychometric Questionnaires in MIMIC Model: A Simulation Study Tue, 20 Jun 2017 00:00:00 +0000 Evaluating measurement equivalence (also known as differential item functioning (DIF)) is an important part of the process of validating psychometric questionnaires. This study aimed at evaluating the multiple indicators multiple causes (MIMIC) model for DIF detection when latent construct distribution is nonnormal and the focal group sample size is small. In this simulation-based study, Type I error rates and power of MIMIC model for detecting uniform-DIF were investigated under different combinations of reference to focal group sample size ratio, magnitude of the uniform-DIF effect, scale length, the number of response categories, and latent trait distribution. Moderate and high skewness in the latent trait distribution led to a decrease of 0.33% and 0.47% power of MIMIC model for detecting uniform-DIF, respectively. The findings indicated that, by increasing the scale length, the number of response categories and magnitude DIF improved the power of MIMIC model, by 3.47%, 4.83%, and 20.35%, respectively; it also decreased Type I error of MIMIC approach by 2.81%, 5.66%, and 0.04%, respectively. This study revealed that power of MIMIC model was at an acceptable level when latent trait distributions were skewed. However, empirical Type I error rate was slightly greater than nominal significance level. Consequently, the MIMIC was recommended for detection of uniform-DIF when latent construct distribution is nonnormal and the focal group sample size is small. Jamshid Jamali, Seyyed Mohammad Taghi Ayatollahi, and Peyman Jafari Copyright © 2017 Jamshid Jamali et al. All rights reserved. The Effects of 6 Months of Progressive High Effort Resistance Training Methods upon Strength, Body Composition, Function, and Wellbeing of Elderly Adults Tue, 06 Jun 2017 09:36:50 +0000 Purpose. The present study examined the progressive implementation of a high effort resistance training (RT) approach in older adults over 6 months and through a 6-month follow-up on strength, body composition, function, and wellbeing of older adults. Methods. Twenty-three older adults (aged 61 to 80 years) completed a 6-month supervised RT intervention applying progressive introduction of higher effort set end points. After completion of the intervention participants could choose to continue performing RT unsupervised until 6-month follow-up. Results. Strength, body composition, function, and wellbeing all significantly improved over the intervention. Over the follow-up, body composition changes reverted to baseline values, strength was reduced though it remained significantly higher than baseline, and wellbeing outcomes were mostly maintained. Comparisons over the follow-up between those who did and those who did not continue with RT revealed no significant differences for changes in any outcome measure. Conclusions. Supervised RT employing progressive application of high effort set end points is well tolerated and effective in improving strength, body composition, function, and wellbeing in older adults. However, whether participants continued, or did not, with RT unsupervised at follow-up had no effect on outcomes perhaps due to reduced effort employed during unsupervised RT. James Steele, Kristin Raubold, Wolfgang Kemmler, James Fisher, Paulo Gentil, and Jürgen Giessing Copyright © 2017 James Steele et al. All rights reserved. Detection of Enterocytozoon bieneusi in White Yaks in Gansu Province, China Tue, 06 Jun 2017 06:31:53 +0000 Enterocytozoon bieneusi, the most common zoonotic pathogen of microsporidiosis, has been found in various animals and humans, but no information is available concerning the prevalence and genotypes of E. bieneusi in white yaks (Bos grunniens). In the present study, 353 faecal samples from white yaks in Tianzhu Tibetan Autonomous County, Gansu Province, Northwestern China, were collected and examined by PCR amplification of the internal transcribed spacer gene to estimate E. bieneusi prevalence and identify their genotypes. Of the 353 faecal samples, 4 (1.13%) were tested E. bieneusi-positive. Sequences analysis revealed that two known genotypes, namely, I () and BEB4 (), and a novel genotype, namely, WCY1 (), were found in this study. Among them, genotype WCY1 was clustered into Group 1, and genotypes I and BEB4 belonged to Group 2. The present study firstly indicates the existence of E. bieneusi in yaks in Gansu Province, Northwestern China. This is also the first record of E. bieneusi in white yaks. Effective measures should be taken to control E. bieneusi infection in white yaks, other animals, and humans. Jian-Gang Ma, Nian-Zhang Zhang, Jun-Ling Hou, Yang Zou, Gui-Xue Hu, Xing-Quan Zhu, and Dong-Hui Zhou Copyright © 2017 Jian-Gang Ma et al. All rights reserved. Effects of an Intensive Lifestyle Intervention to Treat Overweight/Obese Children and Adolescents Mon, 05 Jun 2017 07:33:41 +0000 Objective. The purpose of the present study is to examine the effects of a multidisciplinary lifestyle intervention to treat overweight/obese children and adolescents. The main outcome was cardiometabolic risk based on the waist-to-height ratio (WHTR) measurement. Secondary outcomes were () changes in body composition; () adherence to a Mediterranean diet; and () physical performance. Method. The study involved 74 overweight/obese children or adolescents. The intervention was multidisciplinary including nutrition, exercise, and psychological aspects based on a family-based approach; it was delivered for six months for children and three months for adolescents. Before and after the intervention, several anthropometric measures (height, body weight, body mass index or BMI, waist circumference, and body composition), cardiometabolic risk index (waist-to-height ratio or WHTR), and nutrition habits of the participants and their families were evaluated. In addition, a set of functional motor fitness tests was performed to evaluate physical performance measures. Results. After the intervention both children and adolescents showed a significant reduction in body weight, BMI, waist circumference, fat mass, and WHTR index and an improvement of fat-free mass, adherence to the Mediterranean diet, and physical fitness performance. Conclusion. A family-based multidisciplinary approach is effective in the short term in ameliorating the health status, the nutrition habits, and physical performance in children and adolescents. Claudia Ranucci, Roberto Pippi, Livia Buratta, Cristina Aiello, Vincenza Gianfredi, Natalia Piana, Elisa Reginato, Alberto Tirimagni, Emanuele Chiodini, Emilia Sbroma Tomaro, Alessio Gili, Pierpaolo De Feo, Carmine Fanelli, and Claudia Mazzeschi Copyright © 2017 Claudia Ranucci et al. All rights reserved. Protein Supplementation to Augment the Effects of High Intensity Resistance Training in Untrained Middle-Aged Males: The Randomized Controlled PUSH Trial Thu, 01 Jun 2017 08:28:50 +0000 High intensity (resistance exercise) training (HIT) defined as a “single set resistance exercise to muscular failure” is an efficient exercise method that allows people with low time budgets to realize an adequate training stimulus. Although there is an ongoing discussion, recent meta-analysis suggests the significant superiority of multiple set (MST) methods for body composition and strength parameters. The aim of this study is to determine whether additional protein supplementation may increase the effect of a HIT-protocol on body composition and strength to an equal MST-level. One hundred and twenty untrained males 30–50 years old were randomly allocated to three groups: (a) HIT, (b) HIT and protein supplementation (HIT&P), and (c) waiting-control (CG) and (after cross-over) high volume/high-intensity-training (HVHIT). HIT was defined as “single set to failure protocol” while HVHIT consistently applied two equal sets. Protein supplementation provided an overall intake of 1.5–1.7 g/kg/d/body mass. Primary study endpoint was lean body mass (LBM). LBM significantly improved in all exercise groups (); however only HIT&P and HVHIT differ significantly from control (). HIT diverges significantly from HIT&P () and nonsignificantly from HVHIT (), while no differences were observed for HIT&P versus HVHIT (). In conclusion, moderate to high protein supplementation significantly increases the effects of a HIT-protocol on LBM in middle-aged untrained males. Andreas Wittke, Simon von Stengel, Michael Hettchen, Michael Fröhlich, Jürgen Giessing, Michael Lell, Michael Scharf, Michael Bebenek, Matthias Kohl, and Wolfgang Kemmler Copyright © 2017 Andreas Wittke et al. All rights reserved. Dual Epidemics of Club Drug Use and Sexually Transmitted Infections among Chinese Female Sex Workers: New Challenges to STI Prevention Tue, 30 May 2017 00:00:00 +0000 Objectives. To evaluate club drug use and its potential association with STI among female sex workers (FSWs) in China. Methods. From November 2008 to January 2009, participants were recruited at sex work venues in five cities for a questionnaire survey. Free testing for syphilis, Chlamydia trachomatis (CT), and Neisseria gonorrhoeae (NG) was provided. Logistic regression models were used to assess factors associated with club drug use and its association with STI. Results. A total of 1604 eligible FSWs were included. The overall prevalence of any STI infection and club drug use in the past 12 months was 22.6% and 7.4%, respectively. STI prevalence was significantly higher among club drug users (33.1%) than among nonusers (21.7%, ). Multivariable logistic regression found that club drug use was associated with younger age (AOR 2.4, 95% CI 1.0, 6.0), higher education, having injected drugs (AOR 24.4, 95% CI 6.2, 96.8), and having had STI symptoms (AOR 2.2, 95% CI 1.4, 3.4). Conclusions. Club drug use and STI were highly prevalent among FSWs in China, especially among young FSWs. Club drug users had more risk behaviors and higher STI rates. A coordinated risk reduction framework is urgently needed to address the dual epidemic of drug use and STI. Jing Li, Xiang-dong Gong, Xiaoli Yue, and Ning Jiang Copyright © 2017 Jing Li et al. All rights reserved. Personalized Consent Flow in Contemporary Data Sharing for Medical Research: A Viewpoint Tue, 30 May 2017 00:00:00 +0000 Background. Health data personally collected by individuals with wearable devices and smartphones is becoming an important data source for healthcare, but also for medical research. Objective. To describe a new consent model that allows people to control their personally collected health data and determine to what extent they want to share these for research purposes. Methods. We developed, in close collaboration with patients, researchers, healthcare professionals, privacy experts, and an accredited Medical Ethical Review Committee, an innovative concept called “personalized consent flow” within a research platform connected to a personal health record. The development was an iterative process with informal meetings, semistructured interviews, and surveys. The final concept of the personalized consent flow was reviewed by patients and improved and approved by the same patients in a focus group. Results. This concept could result in optimal control for individual users, since they will answer questions about how they will share data. Furthermore, it enables users to collect data for specific studies and add expiration dates to their data. This work facilitates further discussion about dynamic and personalized consent. A pilot study with the personalized consent model is currently being carried out. Ester A. Rake, Marleen M. H. J. van Gelder, David C. Grim, Barend Heeren, Lucien J. L. P. G. Engelen, and Tom H. van de Belt Copyright © 2017 Ester A. Rake et al. All rights reserved. Prevalence of Malnutrition and Associated Factors among Children in Rural Ethiopia Wed, 17 May 2017 08:17:05 +0000 Background. Child malnutrition continues to be the leading public health problem in developing countries. In Ethiopia, malnutrition is a leading cause of child illness and death. Recently the composite index of anthropometric failure (CIAF) has been implemented to measure the prevalence of malnutrition. This index presents a more complete picture compared with the previous conventional indices. In this study, CIAF was used to determine the prevalence of malnutrition among children aged 0–59 months in rural Ethiopia. Methods. Data was extracted from the 2014 Ethiopian Mini Demographic and Health Survey (EMDHS) for this study. A total of 3095 children were included in the analysis. The composite index of anthropometric failure (CIAF) was used to measure the nutritional status of the children. Logistic regression was fitted, to identify factors associated with malnutrition among children in rural Ethiopia, using STATA 13. Result. The prevalence of malnutrition among rural children in Ethiopia was 48.5%. Age of the children, preceding birth interval, educated status of mother, wealth status, and region were factors independently associated with nutritional status of children in rural Ethiopia. Conclusion. The prevalence of malnutrition among children in rural Ethiopia was high. A child older than 12 months, having uneducated mother, living in a household with poor wealth status, born with short birth interval, and living in some region of the country are associated with increased odds of being malnourished. Neima Endris, Henok Asefa, and Lamessa Dube Copyright © 2017 Neima Endris et al. All rights reserved. Psychosocial and Environmental Correlates of Sedentary Behaviors in Spanish Children Thu, 27 Apr 2017 00:00:00 +0000 Purpose. To evaluate children’s psychosocial and environmental factors associated with sedentary behavior (SB). Method. The study involved a total of 420 children (mean 9.2 years; 52.9% girls) from the community of Madrid, Spain. SB and physical activity (PA) were objectively measured using accelerometers. TV viewing and potential correlates were assessed by questionnaire. Mixed-model regression analysis, adjusted for clustering within school locations, evaluated the relation of each independent variable with SBs. Results. Girls showed higher levels of SB than boys, whereas boys reported more TV viewing ( in all cases). Regression analysis showed that MVPA levels were negatively related to objective SB measurement in both boys and girls (). Parent and friend support to PA were negatively associated with SB on weekdays in boys and girls, respectively (). In the boys’ group, parental professional level was a positive predictor of SB on weekend days (). Boys with more positive neighborhood perceptions spent less time watching TV (), whereas mother’s leisure-time PA level was a negative correlate of TV viewing in girls’ group (). Conclusion. Different psychosocial and environmental correlates of SB were identified. Present findings are promising targets for interventions to improve children’s health. S. Aznar, M. T. Lara, A. Queralt, and J. Molina-Garcia Copyright © 2017 S. Aznar et al. All rights reserved. Seroprevalence and Risk Factors of Bluetongue Virus Infection in Tibetan Sheep and Yaks in Tibetan Plateau, China Sun, 23 Apr 2017 06:42:59 +0000 Bluetongue (BT), caused by bluetongue virus (BTV), is an arthropod-borne viral disease in ruminants. However, information about BTV infection in yaks in China is limited. Moreover, no such data concerning BTV in Tibetan sheep is available. Therefore, 3771 serum samples were collected from 2187 Tibetan sheep and 1584 yaks between April 2013 and March 2014 from Tibetan Plateau, western China, and tested for BTV antibodies using a commercially available ELISA kit. The overall seroprevalence of BTV was 17.34% (654/3771), with 20.3% (443/2187) in Tibetan sheep and 13.3% (211/1584) in yaks. In the Tibetan sheep group, the seroprevalence of BTV in Luqu, Maqu, Tianzhu, and Nyingchi Prefecture was 20.3%, 20.8%, 20.5%, and 19.1%, respectively. The seroprevalence of BTV in different season groups varied from 16.5% to 23.4%. In the yak group, BTV seroprevalence was 12.6%, 15.5%, and 11.0% in Tianzhu, Maqu, and Luqu counties, respectively. The seroprevalence in different seasons was 12.6%, 15.5%, 15.4%, and 9.0% in spring, summer, autumn, and winter, respectively. The season was the major risk factor concerning BTV infection in yaks (). The date of the BTV seroprevalence in Tibetan sheep and yaks provides baseline information for controlling BT in ruminants in western China. Jian-Gang Ma, Xiao-Xuan Zhang, Wen-Bin Zheng, Ying-Tian Xu, Xing-Quan Zhu, Gui-Xue Hu, and Dong-Hui Zhou Copyright © 2017 Jian-Gang Ma et al. All rights reserved. Indigenous Wildlife Rabies in Taiwan: Ferret Badgers, a Long Term Terrestrial Reservoir Wed, 12 Apr 2017 08:05:42 +0000 The emerging disease of rabies was confirmed in Taiwan ferret badgers (FBs) and reported to the World Organization for Animal Health (OIE) on July 17, 2013. The spread of wildlife rabies can be related to neighborhood countries in Asia. The phylogenetic analysis was conducted by maximum likelihood (ML) methods and the Bayesian coalescent approach based on the glycoprotein (G) and nucleoprotein (N) genes. The phylogeographic and spatial temporal dynamics of viral transmission were determined by using SPREAD, QGIS. Therefore, the origin and the change with time of the viruses can be identified. Results showed the rabies virus of FB strains in Taiwan is a unique clade among other strains in Asia. According to the phylogeographic coalescent tree, three major genotypes of the FB rabies virus have circulated in three different geographical areas in Taiwan. Two genotypes have distributed into central and southern Taiwan between two ecological river barriers. The third genotype has been limited in southeastern Taiwan by the natural mountain barrier. The diversity of FB rabies viruses indicates that the biological profile of FBs could vary in different geographical areas in Taiwan. An enhanced surveillance system needs to be established near the currently identified natural barriers for early warnings of the rabies virus outbreak in Taiwan. Yu-Ching Lan, Tzai-Hung Wen, Chao-chin Chang, Hsin-Fu Liu, Pei-Fen Lee, Chung-Yuan Huang, Bruno B. Chomel, and Yi-Ming A. Chen Copyright © 2017 Yu-Ching Lan et al. All rights reserved. Blood Lead Levels and Risk Factors among Preschool Children in a Lead Polluted Area in Taizhou, China Wed, 29 Mar 2017 07:41:31 +0000 Objective. To determine the blood lead levels and identify related risk factors among preschool children in a lead polluted area (Taizhou, China) and provide theoretical support for prevention of lead pollution. Methods. A stratified-clustered-random sampling method was used to determine the survey sample. Blood lead levels were determined by the tungsten atomizer absorption spectrophotometer. Results. A total of 2,018 subjects (average age of 59 months; 1,087 boys and 931 girls) were included. The arithmetic mean, geometric mean, and median blood lead levels of the preschool children were 56.4 μg/L, 48.9 μg/L, and 46 μg/L. A total of 8.8% children had blood lead levels >100 μg/L and 43.9% had blood lead levels >50 μg/L. Mother’s education level, father’s occupation, decorative tableware, exposure to makeup, and the residential floor were all risk factors for elevated blood lead levels (odds ratios of 1.42, 1.21, 1.11, 1.19, and 1.27, resp.), while hand washing before eating food was a protective factor (odds ratio of 0.88). Conclusions. The blood lead levels of preschool children in Taizhou were higher than in other areas in China and in developed countries. Therefore, policies ensuring lead-based industries are not placed in close proximity to residential areas are required. Zhenyan Gao, Jia Cao, Jin Yan, Ju Wang, Shizhong Cai, and Chonghuai Yan Copyright © 2017 Zhenyan Gao et al. All rights reserved. Different Types of Physical Activity and Fitness and Health in Adults: An 18-Year Longitudinal Study Wed, 29 Mar 2017 00:00:00 +0000 Objective. The aim of this study is to examine the relationship between different types of daily life physical activity (PA) and physical fitness (PF) and health throughout adulthood. Methods. A total of 723 men and women, aged 28–76 years, participated 1681 times during four measurement points from 1992 to 2010 in this study. We assessed self-reported PA, anthropometrics, physical health status (HS), and PF in each study year. Hierarchical linear modeling (HLM) was used to analyze the measures. Results. PF and HS worsened with increasing age while sports activity (SA) declined. The modeling showed that sex, age, and SES play important roles concerning PA, PF, and HS. Athletes show higher HS and HF than nonathletes. Habitual activity (HA) also showed a positive relationship with PF and HS, but effects were lower than for SA. Work related activity (WRA) showed no meaningful relationship with PF or HS. Conclusions. Comparable amounts of PA can lead to different effects on PF or HS. Our findings underline the importance of contexts, content, and purposes of PA when health or fitness benefits are addressed. Simply moving your body is not enough. Steffen C. E. Schmidt, Susanne Tittlbach, Klaus Bös, and Alexander Woll Copyright © 2017 Steffen C. E. Schmidt et al. All rights reserved. Evaluation of Mobile Phone and Cordless Phone Use and Glioma Risk Using the Bradford Hill Viewpoints from 1965 on Association or Causation Thu, 16 Mar 2017 00:00:00 +0000 Objective. Bradford Hill’s viewpoints from 1965 on association or causation were used on glioma risk and use of mobile or cordless phones. Methods. All nine viewpoints were evaluated based on epidemiology and laboratory studies. Results. Strength: meta-analysis of case-control studies gave odds ratio (OR) = 1.90, 95% confidence interval (CI) = 1.31–2.76 with highest cumulative exposure. Consistency: the risk increased with latency, meta-analysis gave in the 10+ years’ latency group OR = 1.62, 95% CI = 1.20–2.19. Specificity: increased risk for glioma was in the temporal lobe. Using meningioma cases as comparison group still increased the risk. Temporality: highest risk was in the 20+ years’ latency group, OR = 2.01, 95% CI =1.41–2.88, for wireless phones. Biological gradient: cumulative use of wireless phones increased the risk. Plausibility: animal studies showed an increased incidence of glioma and malignant schwannoma in rats exposed to radiofrequency (RF) radiation. There is increased production of reactive oxygen species (ROS) from RF radiation. Coherence: there is a change in the natural history of glioma and increasing incidence. Experiment: antioxidants reduced ROS production from RF radiation. Analogy: there is an increased risk in subjects exposed to extremely low-frequency electromagnetic fields. Conclusion. RF radiation should be regarded as a human carcinogen causing glioma. Michael Carlberg and Lennart Hardell Copyright © 2017 Michael Carlberg and Lennart Hardell. All rights reserved. Testing for HIV/STIs in China: Challenges, Opportunities, and Innovations Sun, 19 Feb 2017 08:11:07 +0000 Huachun Zou, Lei Zhang, Eric P. F. Chow, Weiming Tang, and Zixin Wang Copyright © 2017 Huachun Zou et al. All rights reserved. Impact of Physical Activity on Cognitive Decline, Dementia, and Its Subtypes: Meta-Analysis of Prospective Studies Tue, 07 Feb 2017 00:00:00 +0000 The association of physical activity with dementia and its subtypes has remained controversial in the literature and has continued to be a subject of debate among researchers. A systematic review and meta-analysis of longitudinal studies on the relationship between physical activity and the risk of cognitive decline, all-cause dementia, Alzheimer’s disease, and vascular dementia among nondemented subjects are considered. A comprehensive literature search in all available databases was conducted up until April 2016. Well-defined inclusion and exclusion criteria were developed with focus on prospective studies ≥ 12 months. The overall sample from all studies is 117410 with the highest follow-up of 28 years. The analyses are performed with both Bayesian parametric and nonparametric models. Our analysis reveals a protective effect for high physical activity on all-cause dementia, odds ratio of 0.79, 95% CI (0.69, 0.88), a higher and better protective effect for Alzheimer’s disease, odds ratio of 0.62, 95% CI (0.49, 0.75), cognitive decline odds ratio of 0.67, 95% CI (0.55, 0.78), and a nonprotective effect for vascular dementia of 0.92, 95% CI (0.62, 1.30). Our findings suggest that physical activity is more protective against Alzheimer’s disease than it is for all-cause dementia, vascular dementia, and cognitive decline. Chris B. Guure, Noor A. Ibrahim, Mohd B. Adam, and Salmiah Md Said Copyright © 2017 Chris B. Guure et al. All rights reserved. Maternal Prepregnancy BMI and Glucose Level at 24–28 Gestational Weeks on Offspring’s Overweight Status within 3 Years of Age Mon, 30 Jan 2017 10:06:42 +0000 Objective. To examine the relative impact of maternal prepregnancy body mass index (BMI) and glucose level at 24–28 gestational weeks on offspring’s overweight status from birth to 3 years of age in China. Methods. Health care records of 21,354 mother-child pairs were collected. The single and joint associations of maternal prepregnancy BMI and glucose level at 24–28 gestational weeks with 0–3-year-old offspring’s overweight status were assessed. Results. The odds ratios (95% confidence intervals) of offspring’s macrosomia at birth and overweight/obesity at the 12th month, 24th month, and 36th month were 1.12 (1.11–1.13), 1.05 (1.04–1.06), 1.07 (1.06–1.08), and 1.11 (1.10–1.12) for each 1-unit increase (km/m2) in maternal prepregnancy BMI and 1.13 (1.10–1.17), 1.01 (0.99–1.03), 0.99 (0.96–1.01), and 1.00 (0.97–1.02) for each 1-unit increase (mmol/L) in maternal glucose level at 24–28 gestational weeks, respectively. The positive association of maternal glucose level with macrosomia at birth was similar between prepregnancy normal weight (BMI < 24 kg/m2) and overweight (BMI ≥ 24 kg/m2); however, the positive association of high maternal glucose level with childhood overweight was only seen among prepregnancy normal weight mothers but not among overweight mothers. Conclusions. The impact of maternal gestational hyperglycemia on offspring’s overweight before 3 years of age can be modified by prepregnancy BMI. Weiqin Li, Leishen Wang, Nan Li, Wei Li, Huikun Liu, Shuang Zhang, Gang Hu, and Junhong Leng Copyright © 2017 Weiqin Li et al. All rights reserved. The Use of Antidepressants, Anxiolytics, and Hypnotics in People with Type 2 Diabetes and Patterns Associated with Use: The Hoorn Diabetes Care System Cohort Mon, 23 Jan 2017 09:46:16 +0000 Objective. With depression being present in approximately 20% of people with type 2 diabetes mellitus (T2DM), we expect equally frequent prescription of antidepressants, anxiolytics, and hypnotics. Nevertheless, prescription data in people with T2DM is missing and the effect of depression on glycaemic control is contradictory. The aim of this study was to assess the prevalence of antidepressants, anxiolytics, and/or hypnotics use in a large, managed, primary care system cohort of people with T2DM and to determine the sociodemographic characteristics, comorbidities, T2DM medication, and metabolic control associated with its use. Method. The prevalence of antidepressants, anxiolytics, and/or hypnotics use in the years 2007–2012 was assessed in the Hoorn Diabetes Care System Cohort from the Netherlands. Results. From the 7016 people with T2DM, 500 people (7.1%) used antidepressants only, 456 people (6.5%) used anxiolytics and/or hypnotics only, and 254 people (3.6%) used a combination. Conclusion. We conclude that in our managed, primary care system 17% of all people with T2DM used antidepressants, anxiolytics, and/or hypnotics. Users of antidepressants, anxiolytics, and/or hypnotics were more often female, non-Caucasian, lower educated, and more often treated with insulin. R. Mast, S. P. Rauh, L. Groeneveld, A. D. Koopman, J. W. J. Beulens, A. P. D. Jansen, M. Bremmer, A. A. W. A. van der Heijden, P. J. Elders, J. M. Dekker, G. Nijpels, J. G. Hugtenburg, and F. Rutters Copyright © 2017 R. Mast et al. All rights reserved. Human Papillomavirus Positivity in the Anal Canal in HIV-Infected and HIV-Uninfected Men Who Have Anal Sex with Men in Guangzhou, China: Implication for Anal Exams and Early Vaccination Wed, 04 Jan 2017 09:34:27 +0000 Background. The epidemiology of HPV in men who have sex with men (MSM) in Guangzhou, China, had not been reported previously. Methods. HIV-infected and HIV-uninfected MSM were recruited from a Guangzhou-based MSM clinic in 2013. Sociodemographic characteristics and sexual behaviors were collected. An anal cytological sample was taken for HPV testing. Results. We recruited 79 HIV-infected and 85 HIV-uninfected MSM. The median age was 26 years in both groups. The positivities of anal HPV of any type (81.0% versus 48.2%), any high risk type (50.6% versus 27.1%), any low risk type (55.7% versus 31.8%), and any 9-valent vaccine type (74.7% versus 36.5%) were all significantly higher among HIV-infected compared to that among HIV-negative MSM ( for all < 0.05). The great majority of HPV-infected MSM were infected with 9-valent vaccine types (59 out of 64 HIV-infected and 31 out of 41 HIV-uninfected). Anal bacterial infections were associated with higher anal HPV positivity and greater number of anal HPV types. Conclusion. Sexually active MSM in Guangzhou, especially those infected with HIV, had high and multiple HPV detections. The majority of these cases were potentially preventable by HPV vaccine. Regular anal exams and early HPV vaccination are warranted in this population. Xuqi Ren, Wujian Ke, Heping Zheng, Ligang Yang, Shujie Huang, Xiaolin Qin, Bin Yang, and Huachun Zou Copyright © 2017 Xuqi Ren et al. All rights reserved. Internet-Based Sex-Seeking Behavior Promotes HIV Infection Risk: A 6-Year Serial Cross-Sectional Survey to MSM in Shenyang, China Sun, 25 Dec 2016 09:17:59 +0000 HIV prevalence is still rapidly increasing among Chinese men who have sex with men (MSM). The Internet also makes it easier for MSM to have casual partners. This study aims to evaluate the trend of Internet-based sex-seeking behavior of MSM and its impact on HIV prevalence, the distribution of HIV subtype strains, and transmitted drug resistance rates. A serial cross-sectional study was conducted from 2009 to 2014. Of the 1,981 MSM, 50.5% (1,000/1,981) mainly sought homosexual partners through the Internet (Internet-based MSM, IBM). The proportion of IBM among total MSM subjects increased from 43.3% to 61.5% (). HIV prevalence of IBM increased from 5.7% to 20.7%, while that of non-Internet-based MSM (NIBM) increased from 7.0% to 14.7%. A relative higher proportion of NIBM were infected with HIV CRF01_AE subtype than IBM (79.5% versus 72.2%, ). Multivariable analysis found IBM had a significantly higher HIV prevalence than NIBM (13.2% versus 10.5%, aOR = 1.4, 95% CI [1.0–1.9]). Being a migrant non-Shenyang resident MSM (aOR = 1.9, 95% CI [1.3–2.9]) and occasionally/never using condoms with casual homosexual partners (aOR = 1.7, 95% CI [1.1–2.6]) were two distinct risk factors for HIV infection in IBM. More efforts should be targeted towards developing interventions aimed at IBM, particularly migrant MSM and who engage in UAI with casual homosexual partners. Shi Pan, Jun-Jie Xu, Xiao-Xu Han, Jing Zhang, Qing-Hai Hu, Zhen-Xing Chu, Yan-Qiu Hai, Xiang Mao, Yan-Qiu Yu, Wen-Qing Geng, Yong-Jun Jiang, and Hong Shang Copyright © 2016 Shi Pan et al. All rights reserved. Gaps in the Continuum of HIV Care: Long Pretreatment Waiting Time between HIV Diagnosis and Antiretroviral Therapy Initiation Leads to Poor Treatment Adherence and Outcomes Thu, 22 Dec 2016 06:42:26 +0000 Background. Criteria for antiretroviral treatment (ART) were adjusted to enable early HIV treatment for people living HIV/AIDS (PLHIV) in China in recent years. This study aims to determine how pretreatment waiting time after HIV confirmation affects subsequent adherence and outcomes over the course of treatment. Methods. A retrospective observational cohort study was conducted using treatment data from PLHIV in Yuxi, China, between January 2004 and December 2015. Results. Of 1,663 participants, 348 were delayed testers and mostly initiated treatment within 28 days. In comparison, 1,315 were nondelayed testers and the median pretreatment waiting time was 599 days, but it significantly declined over the study period. Pretreatment CD4 T-cell count drop (every 100 cells/mm3) contributed slowly in CD4 recovery after treatment initiation (8% less, ) and increased the risk of poor treatment adherence by 15% (ARR = 1.15, 1.08–1.25). Every 100 days of extensive pretreatment waiting time increased rates of loss to follow-up by 20% (ARR = 1.20, 1.07–1.29) and mortality rate by 11% (ARR = 1.11, 1.06–1.21), based on multivariable Cox regression. Conclusion. Long pretreatment waiting time in PLHIV can lead to higher risk of poor treatment adherence and HIV-related mortality. Current treatment guidelines should be updated to provide ART promptly. Shu Su, Shifu Li, Shunxiang Li, Liangmin Gao, Ying Cai, Jincui Fu, Chunyuan Guo, Jun Jing, Liang Chen, Limin Mao, Feng Cheng, and Lei Zhang Copyright © 2016 Shu Su et al. All rights reserved. Depression and HIV Risk Behaviors among Female Sex Workers in Guangdong, China: A Multicenter Cross-Sectional Study Tue, 20 Dec 2016 09:22:59 +0000 Background. Our study aimed to assess the burden of depression and evaluate factors associated with depression and status of HIV risk behaviors among female sex workers (FSWs) in Guangdong, China. Method. We recruited FSWs from massage parlors, saunas, restaurants, hotels, hair salons, and streets in Guangdong, China, in 2014. Information on demographic characteristics, HIV testing history, and sexual behaviors was collected using a questionnaire. A blood sample was collected to test for HIV, syphilis, and HCV. A participant was defined as being depressed if she obtained 6 points or above using the 12-item General Health Questionnaire. Results. Among the 653 participants, 41.7% were 21–30 years old and 43.6% married. Overall, 52.4% were found to be depressed. FSWs who had correct syphilis related knowledge [aOR = 1.45; 95% CI: 1.04–2.03] and had primary sex partner (1.63, 1.14–2.33) were more likely to be depressed. FSWs who did not use a condom during their last sex with the primary sex partner were less likely to be depressed (0.47, 0.31–0.71). Conclusion. Our study observed high level of depression and HIV risk behaviors among Chinese FSWs. Future interventions should integrate mental health services in comprehensive interventions to prevent depression among Chinese FSWs. Hongcheng Shen, Huachun Zou, Shujie Huang, Fengying Liu, Peizhen Zhao, Lei Chen, Ye Zhang, Xiaomin Luo, Weiming Tang, Heping Zheng, and Bin Yang Copyright © 2016 Hongcheng Shen et al. All rights reserved. The Functional Haplotypes of CHRM3 Modulate mRNA Expression and Associate with Bladder Cancer among a Chinese Han Population in Kaohsiung City Wed, 07 Dec 2016 11:06:50 +0000 Bladder cancer is one of the major cancer types and both environmental factors and genetic background play important roles in its pathology. Kaohsiung is a high industrialized city in Taiwan, and here we focused on this region to evaluate the genetic effects on bladder cancer. Muscarinic acetylcholine receptor M3 (CHRM3) was reported as a key receptor in different cancer types. CHRM3 is located at 1q42-43 which was reported to associate with bladder cancer. Our study attempted to delineate whether genetic variants of CHRM3 contribute to bladder cancer in Chinese Han population in south Taiwan. Five selected SNPs (rs2165870, rs10802789, rs685550, rs7520974, and rs3738435) were genotyped for 30 bladder cancer patients and 60 control individuals and genetic association studies were performed. Five haplotypes (GTTAT, ATTGT, GCTAC, ACTAC, and ACCAC) were found significantly associated with low CHRM3 mRNA level and contributed to increased susceptibility of bladder cancer in Kaohsiung city after rigid 10000 consecutive permutation tests. To our knowledge, this is the first genetic association study that reveals the genetic contribution of CHRM3 gene in bladder cancer etiology. Chiang-Ting Wang, Tsung-Ming Chen, Chien-Tai Mei, Chun-Feng Chang, Li-Lian Liu, Kuo-Hsun Chiu, Tsung-Meng Wu, Yu-Ching Lan, Wen-Sheng Liu, Ya-Huey Chen, and Yi-Mei Joy Lin Copyright © 2016 Chiang-Ting Wang et al. All rights reserved. Early Sexual Debut and HIV Infection among Men Who Have Sex with Men in Shenzhen, China Mon, 28 Nov 2016 14:26:41 +0000 Studies investigating the association between early sexual debut and human immunodeficiency virus (HIV) infection have mainly focused on Africans or females but rarely on men who have sex with men (MSM) in China. This study, therefore, mainly aimed at exploring the association between early sexual debut and HIV infection among MSM in Shenzhen, China. A total of 533 MSM were enrolled in this study using a convenience sampling method. Information about sociodemographic characteristics and risky sexual behaviors was collected. It was found that the prevalence of HIV infection was 24.2% among this study population and 66.4% of the MSM reported having had vaginal sexual intercourse with females. The mean ages at first vaginal sexual intercourse, first anal sexual intercourse, and first sexual intercourse were 21.38, 22.43, and 19.87 years, respectively. Multivariable logistic regression analyses showed that the MSM who experienced early anal sexual debut were more likely to be infected with HIV than those who did not. The results indicate that HIV infection is quite prevalent among MSM in Shenzhen. Early and efficient intervention strategies should be taken, and the MSM experiencing early anal sexual debut should be given special attention. Ruiwei Xu, Wenjie Dai, Guanglu Zhao, Dan Tu, Lin Yang, Feng Wang, Yumao Cai, Lina Lan, Hongzhuan Tan, Aizhong Liu, Tiejian Feng, and Atipatsa C. Kaminga Copyright © 2016 Ruiwei Xu et al. All rights reserved. Evaluating the Primary Prevention of Ischemic Stroke of Oral Antithrombotic Therapy in Head and Neck Cancer Patients with Radiation Therapy Mon, 21 Nov 2016 14:33:35 +0000 Although previous studies demonstrated the risk of ischemic stroke (IS) in patients with head and neck cancer (HNC), the impact of oral antithrombotic therapy (OAT) on this risk has not yet been assessed. We aimed to evaluate the effectiveness and safety of OAT in patients with HNC treated with RT. This retrospective cohort study was performed using the National Health Insurance Research Database of Taiwan. A total of 37,638 patients diagnosed with HNC included in the study were classified as users and nonusers of OAT. Primary outcome was IS or transient ischemic attack (TIA), and secondary outcomes were death and major bleeding. The Cox proportional hazards model was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). There was no significant difference in the risk of IS or TIA between patients on continuous OAT and nonusers (adjusted HR, 0.812; 95% CI, 0.199–3.309). The risk of major bleeding was not significantly different between the groups. From a national population database, we did not find an association between OAT and decreasing risk of ischemic stroke/TIA or increasing hazard of major bleeding. Chin-Wei Hsu, Yaw-Bin Huang, Chen-Chun Kuo, and Chung-Yu Chen Copyright © 2016 Chin-Wei Hsu et al. All rights reserved. HIV-1 Epidemiology, Genetic Diversity, and Primary Drug Resistance in the Tyumen Oblast, Russia Sun, 13 Nov 2016 12:30:46 +0000 Introduction. Specific molecular epidemic features of HIV infection in Tyumen Oblast (TO), Russia, were studied. Methods. The genome sequences encoding HIV-1 protease-reverse transcriptase, integrase, and major envelope protein were examined for 72 HIV-1 specimens isolated from the TO resident infected in 2000–2015. Results. The recorded prevalence of HIV-1 subtype A (A1) is 93.1%; HIV-1 subtype B continues to circulate in MSM risk group (1.4%). Solitary instances of HIV-1 recombinant forms, CRF63_02A1 (1.4%) and CRF03_AB (1.4%), were detected as well as two cases of HIV-1 URF63_A1 (2.8%). Phylogenetic analysis showed no HIV-1 clustering according to the duration of infection and risk groups but revealed different epidemic networks confirming that HIV infection spread within local epidemic foci. A high incidence of CXCR4-tropic HIV-1 variants and a higher rate of secondary mutations influencing the virus fitness (K20R, L10V, and I) are observed among the virus specimens isolated from newly infected individuals. Conclusions. The current HIV-1 epidemic in TO develops within the local epidemic networks. Similar to the previous period, HIV-1 subtype A is predominant in TO with sporadic cases of importation of HIV-1 recombinant forms circulating in adjacent areas. Natalya M. Gashnikova, Ekaterina M. Astakhova, Mariya P. Gashnikova, Evgeniy F. Bocharov, Svetlana V. Petrova, Olga A. Pun’ko, Alexander V. Popkov, and Aleksey V. Totmenin Copyright © 2016 Natalya M. Gashnikova et al. All rights reserved. Comorbidity in Adult Patients Hospitalized with Type 2 Diabetes in Northeast China: An Analysis of Hospital Discharge Data from 2002 to 2013 Tue, 25 Oct 2016 07:35:31 +0000 This study aims to evaluate the comorbidity burden and patterns among adult patients hospitalized with a diagnosis of type 2 diabetes mellitus (T2DM) in Northeast China using hospital discharge data derived from the electronic medical record database between 2002 and 2013. 12.8% of 4,400,892 inpatients aged ≥18 had a diagnosis of T2DM. Sex differences in prevalence varied among those aged <50, 50–59, and ≥60. Twenty-seven diseases were determined as major comorbidities of T2DM. Essential hypertension was the most common comorbidity of T2DM (absolute cooccurrence risk, 58.4%), while T2DM was also the most popular comorbidity of essential hypertension. Peripheral and visceral atherosclerosis showed the strongest association (relative cooccurrence risk, RCoR 4.206). For five leading comorbidities among patients aged ≥40, male patients had a stronger association with disorders of lipid metabolism than female patients (RCoR 2.779 versus 2.099), and female patients had a stronger association with chronic renal failure than male patients (RCoR 2.461 versus 2.155). Leading comorbidities, except chronic renal failure, had declining associations with T2DM with increased age. Collectively, hospital discharge data can be used to estimate disease prevalence and identify comorbidities. The findings provided comprehensive information on comorbidity patterns, helping policy makers and programs in public health domains to estimate and evaluate the epidemic of chronic diseases. Hui Chen, Yaoyun Zhang, Di Wu, Chunxiu Gong, Qing Pan, Xiao Dong, Yonghui Wu, Kuan Zhang, Shiping Wang, Jianbo Lei, and Hua Xu Copyright © 2016 Hui Chen et al. All rights reserved. Prevalence of HIV Antiretroviral Drug Resistance and Its Impacts on HIV-1 Virological Failures in Jiangsu, China: A Cross-Sectional Study Tue, 11 Oct 2016 14:52:22 +0000 Antiretroviral therapy (ART) has been shown to improve survival of patients with Human Immunodeficiency Virus (HIV) infection and to reduce HIV-1 transmission. Therefore, the Chinese central government initiated a national program to provide ART free of charge to HIV-1 patients. We conducted a cross-sectional survey in Jiangsu province to determine the level of drug resistance (DR) in HIV-1 infected patients and the correlates of DR in virological failures in 2012. Approximately 10.4% of the HIV-1 patients in the study experienced virological failure after one year of ART and were divided into drug sensitive and drug resistant groups based on genotype determination. The viral loads (VLs) in the drug resistant group were significantly lower than the drug sensitive group. There were two independent predictors of virological failure: male gender and increasing duration of treatment. The primary mutations observed in the study were against nucleoside reverse transcriptase inhibitors (NRTIs) which were M184V (79.45%) and K103N (33.70%) in nonnucleoside reverse transcriptase inhibitors (NNRTIs). The overall rate of DR in Jiangsu province is still relatively low among treated patients. However, close monitoring of drug resistance in male patients in the early stages of treatment is vital to maintaining and increasing the benefits of HIV ART achieved to date. Ying Zhou, Jing Lu, Jinge Wang, Hongjing Yan, Jianjun Li, Xiaoqin Xu, Zhi Zhang, Tao Qiu, Ping Ding, Gengfeng Fu, Xiping Huan, and Haiyang Hu Copyright © 2016 Ying Zhou et al. All rights reserved. Prevalence and Risk Factors of Colonization with Staphylococcus aureus in Healthy Pet Cats Kept in the City Households Wed, 28 Sep 2016 15:29:11 +0000 Staphylococcus aureus, especially methicillin-resistant S. aureus (MRSA), is a significant pathogen in both human medicine and veterinary medicine. The importance of pets as reservoirs of human infections is still poorly understood. This article provides detailed information of a cross-sectional study of a S. aureus colonization in clinically healthy indoor cats. The study systematically assessed a number of different anatomical locations for the S. aureus colonization and the influence of a range of potential risk factors on the value of the final S. aureus colonization rate. The incidence rates observed for cats with at least one site positive for S. aureus or MRSA were 17.5% and 6.63%, respectively. The following risk factors were identified: one or more owners working in the healthcare industry (human or veterinary); dogs being kept with the cat under investigation; treatment of the cat under investigation with antibiotics or chemotherapeutics during the previous year. In conclusion, this study revealed a higher prevalence of MRSA than what has previously been reported in healthy pets. A combination of anatomical locations from which the samples were collected had a major influence on the final value of the S. aureus colonization rate. Karolina Bierowiec, Katarzyna Płoneczka-Janeczko, and Krzysztof Rypuła Copyright © 2016 Karolina Bierowiec et al. All rights reserved. Late Presentation of HIV Infection: Prevalence, Trends, and the Role of HIV Testing Strategies in Guangzhou, China, 2008–2013 Tue, 27 Sep 2016 12:58:01 +0000 Background. The prevalence, trends, and the role of different HIV testing strategies in late presentation of HIV infection in China were unknown. Methods. Data of newly reported HIV cases in Guangzhou between 2008 and 2013 was analyzed to examine the prevalence, trends, and characteristics of late presentation of HIV infection by three types of HIV testing strategies. Results. Overall, 53.2% (1412/2653) and 27.3% (724/2653) met the criteria of late presentation and presentation with advanced HIV disease. The overall trend of late presentation of HIV infection within the study period was declining. Late presentation was 62.9% in 2008 and dropped to 43.3% in 2013 (); presentation with advanced HIV disease was 40.3% in 2008 and dropped to 15.2% in 2013 (). Of the three testing strategies, PITC presented higher odds of both late presentation [AOR (95% CI): PITC versus VCT: 1.37 (1.09, 1.73); PITC versus MHT: 3.09 (2.16, 4.42)] and presentation with advanced HIV disease [AOR (95% CI): PITC versus VCT: 1.65 (1.29, 2.11); PITC versus MHT: 13.14 (8.47, 20.39)]. Conclusions. Although the late presentation of HIV infection was declining, it was still high in Guangzhou. The worse situation among PITC cases urges the policy adjustment in medical settings to increase early HIV diagnosis. Weibin Cheng, Weiming Tang, Zhigang Han, Thitikarn May Tangthanasup, Fei Zhong, Faju Qin, and Huifang Xu Copyright © 2016 Weibin Cheng et al. All rights reserved. Maternal and Neonatal and Child Health Priorities in Africa and Asia Sun, 18 Sep 2016 13:44:16 +0000 Sten H. Vermund, Renu Garg, Ying-Ru Lo, Emily K. Sheldon, and Kasonde Mwinga Copyright © 2016 World Health Organization. All rights reserved. Comment on “Toxoplasma gondii Infection in Pregnant Women: A Seroprevalence and Case-Control Study in Eastern China” Wed, 14 Sep 2016 09:41:32 +0000 Siddharudha Shivalli and Soujanya Kaup Copyright © 2016 Siddharudha Shivalli and Soujanya Kaup. All rights reserved. Low Neonatal Mortality and High Incidence of Infectious Diseases in a Vietnamese Province Hospital Thu, 11 Aug 2016 11:19:50 +0000 Background. Neonatal deaths constitute the majority of child mortality in Vietnam, but studies are scarce and focus on community settings. Methods. During a 12-month period, all sick neonates admitted to a pediatric department in a province hospital were studied. Potential risk factors of death covering sociodemographic factors, pregnancy history, previous neonatal period, and status on admission were registered. The neonates were followed up until discharge or death or until 28 completed days of age if still hospitalized or until withdrawal of life support. The main outcome was neonatal death. Results. The neonatal mortality was 4.6% (50/1094). In a multivariate analysis, four associated risk factors of death were extremely low birth weight ( (2.3–233.4)), no cry at birth ( (1.3–9.4)), and cyanosis ( (1.2–8.7)) and shock ( (2.5–61.5)) on admission. The major discharge diagnoses were infection, prematurity, congenital malformations, and asphyxia in 88.5% (936/1058), 21.3% (225/1058), 5.0% (53/1058), and 4.6% (49/1058), respectively. In 36, a discharge diagnosis was not registered. Conclusion. Infection was the main cause of neonatal morbidity. Asphyxia and congenital malformations were diagnosed less frequently. The neonatal mortality was 4.6%. No sociodemographic factors were associated with death. Extreme low birth weight, no cry at birth, and cyanosis or shock at admission were associated with death. Binh T. T. Ho, Alexandra Y. Kruse, Hue T. H. Le, Phuong N. Cam, and Freddy K. Pedersen Copyright © 2016 Binh T. T. Ho et al. All rights reserved. A Retrospective Observational Study to Assess Prescription Pattern in Patients with Type B Aortic Dissection and Treatment Outcome Mon, 01 Aug 2016 05:58:14 +0000 Aortic dissection is a life-threatening condition. However, the use of medication to treat it remains unclear in our population, particularly in patients with a type B aortic dissection (TBAD) who do not receive surgery. This retrospective cohort study evaluated antihypertensive prescription patterns and outcomes in patients with nonsurgical TBAD. We reviewed the hospital records of patients with TBAD at a medical center in Taiwan from January 2008 to June 2013 to assess the baseline information, prescribing pattern, event rate, and clinical effectiveness of different antihypertensive treatment strategies. A Cox proportional hazards model was used to estimate outcomes in different antihypertensive strategies. The primary endpoints were all-cause mortality and hospital admission for an aortic dissection. We included 106 patients with a mean follow-up period of 2.75 years. The most common comorbidity was hypertension followed by dyslipidemia and diabetes mellitus. Study endpoints mostly occurred within 6 months after the index date. Over 80% of patients received dual or triple antihypertensive strategies. Patients treated with different treatment strategies did not have a significantly increased risk of a primary outcome compared with those treated with a monotherapy. We found no significant difference in the primary outcome following the use of different antihypertensive medication regimes. Kuang-Ming Liao, Chung-Yu Chen, Shih-Han Wang, Jiann-Woei Huang, Chen-Chun Kuo, and Yaw-Bin Huang Copyright © 2016 Kuang-Ming Liao et al. All rights reserved. Molecular Characterization of High-Risk Human Papillomavirus in Women in Bobo-Dioulasso, Burkina Faso Wed, 20 Jul 2016 11:42:27 +0000 High-risk human papillomavirus (HPV) is found in over 99% of cervical cancers. The aim of this study was to determine the prevalence of HPV in a population of women in Bobo-Dioulasso and to identify the high-risk types present in these women. From May to June, 2015, 181 women who came for consultation at the Souro Sanou University Hospital of Bobo-Dioulasso have been included in this study. Uterine endocervical swabs have been taken in these women. DNA obtained by extraction from the samples thus collected was used to determine the prevalence of high-risk human papillomavirus genotypes through real-time PCR. The age of the women ranged from 20 to 56 years with a mean of years. The prevalence of infection by high-risk HPV types was 25.4% (46/181). The most common high-risk HPV genotypes were HPV 39 (18.5%), HPV 52 (16.7%), HPV 18 (14.8%), and HPV 35 (13.0%). HPV 16 which is included in the HPV vaccines was not found in the population studied. This type of study which is the first one in Bobo-Dioulasso has showed a high prevalence of genotypes HPV 39, HPV 52, and HPV 35 which are not yet covered by a vaccine. Ina Marie Angèle Traore, Théodora Mahoukèdè Zohoncon, Adama Dembele, Florencia W. Djigma, Dorcas Obiri-Yeboah, Germain Traore, Moussa Bambara, Charlemagne Ouedraogo, Yves Traore, and Jacques Simpore Copyright © 2016 Ina Marie Angèle Traore et al. All rights reserved. Outcome of Home-Based Early Intervention for Autism in Sri Lanka: Follow-Up of a Cohort and Comparison with a Nonintervention Group Wed, 22 Jun 2016 06:59:22 +0000 This paper presents the outcome of a home-based autism intervention program (HBAIP) in 18- to 40-month-old children newly diagnosed and treatment naïve. Intervention was exclusively implemented at home. Outcome was measured at 3 months and 6 months after intervention and compared with a group of newly diagnosed children with autism who were >40 months at intake but had not received any autism specific clinical management. Aim was also to estimate whether natural development would contribute to gain in skills and compare with the effect of intervention. Five selected parameters of behavior representing social interaction and social communication were used to assess outcome. Results showed a statistically significant improvement between preintervention and postintervention in all the measured parameters. The effect size was large when compared to preintervention and gains were indicated by changes in mean scores and values within a narrow confidence interval. Highest gains were in first 3 months of postintervention which continued up to 6 months. Although the comparison group was more advanced in the measured skills at intake, they were significantly below the level reached by experimental group at 3 months and 6 months after intervention. This study was registered in the Sri Lanka Clinical Trials Registry (SLCTR/2009/011). Hemamali Perera, Kamal Chandima Jeewandara, Sudarshi Seneviratne, and Chandima Guruge Copyright © 2016 Hemamali Perera et al. All rights reserved. Turning Disaster into an Opportunity for Quality Improvement in Essential Intrapartum and Newborn Care Services in the Philippines: Pre- to Posttraining Assessments Wed, 15 Jun 2016 09:34:06 +0000 Background. On 8 November 2013, supertyphoon Haiyan made landfall in the Philippines, severely disrupting health service delivery. Reestablishment of essential services for birthing mothers and their newborns became high priority. Methodology. Following a baseline assessment, an Essential Intrapartum and Newborn Care (EINC) training package was implemented and posttraining assessments (1 and 3 months after training) were undertaken. Results. Baseline assessments ( facilities) revealed gaps in provider’s skill and shortage of life-saving commodities. Facilities lacked newborn bags/masks (9%), towels (6%), and magnesium sulfate (39%). Service providers lacked skills in partograph use (54%), antenatal steroid (44%) use, and breastfeeding initiation (50%). At 3 months after training ( facilities), dramatic increases in correct partograph use (to 92%), antenatal steroid use (to 98%), breastfeeding initiation (to 86%), kangaroo mother care (to 94%), availability of magnesium sulfate (to 94%), and bag/masks (to 88%) were documented. Gaps persisted for skills in assisted vaginal delivery and removal of placental fragments. Conclusion. Health services were severely disrupted after supertyphoon Haiyan. Our study demonstrates that essential birthing services and quality improvements to strengthen local health systems can be restored in a timely manner even in immediate postdisaster settings. M. S. Castillo, M. A. Corsino, A. P. Calibo, W. Zeck, D. S. Capili, L. C. Andrade, K. A. Reyes, R. C. Alfonso, M. B. Ponferrada, and M. A. Silvestre Copyright © 2016 M. S. Castillo et al. All rights reserved. First Report of Bovine Leukemia Virus Infection in Yaks (Bos mutus) in China Thu, 02 Jun 2016 12:46:10 +0000 Enzootic bovine leukosis (EBL) is a chronic lymphosarcoma disease of cattle caused by bovine leukemia virus (BLV). No information is available concerning the epidemiology of BLV infection in yaks (Bos mutus). One thousand five hundred and eighty-four serum samples from 610 black yaks and 974 white yaks from Gansu province, northwest China, were collected between April 2013 and March 2014 and tested for BLV antibodies using a commercially available ELISA kit. The overall BLV seroprevalence in yaks was 21.09% (334/1584), with 24.26% (148/610) black yaks and 19.10% (186/974) white yaks yielding positive results. Risk factor analysis indicated that with the exception of breed (OR = 1.36, 95% CI = 1.06–1.73, ), the age, region, gender, farm, and the numbers of pregnancies were not considered as risk factors for the presence of BLV in yaks included in this study. This is the first report of BLV infection in yaks in China, which provides information for controlling BLV infection in yaks. Jian-Gang Ma, Wen-Bin Zheng, Dong-Hui Zhou, Si-Yuan Qin, Ming-Yang Yin, Xing-Quan Zhu, and Gui-Xue Hu Copyright © 2016 Jian-Gang Ma et al. All rights reserved. Prenatal Maternal Anxiety as a Risk Factor for Preterm Birth and the Effects of Heterogeneity on This Relationship: A Systematic Review and Meta-Analysis Thu, 19 May 2016 12:04:38 +0000 Background. Systematic reviews (SR) and meta-analyses (MA) that previously explored the relationship between prenatal maternal anxiety (PMA) and preterm birth (PTB) have not been comprehensive in study inclusion, failing to account for effects of heterogeneity and disagree in their conclusions. Objectives. This SRMA provides a summary of the published evidence of the relationship between PMA and PTB while examining methodological and statistical sources of heterogeneity. Methods. Published studies from MEDLINE, CINAHL, PsycINFO, and EMBASE, until June 2015, were extracted and reviewed. Results. Of the 37 eligible studies, 31 were used in this MA; six more were subsequently excluded due to statistical issues, substantially reducing the heterogeneity. The odds ratio for PMA was 1.70 (95% CI 1.33, 2.18) for PTB and 1.67 (95% CI 1.35, 2.07) for spontaneous PTB comparing higher levels of anxiety to lower levels. Conclusions. Consistent findings indicate a significant association between PMA and PTB. Due to the statistical problem of including collinear variables in a single regression model, it is hard to distinguish the effect of the various types of psychosocial distress on PTB. However, a prenatal program aimed at addressing mental health issues could be designed and evaluated using a randomised controlled trial to assess the causal nature of different aspects of mental health on PTB. M. Sarah Rose, Gianella Pana, and Shahirose Premji Copyright © 2016 M. Sarah Rose et al. All rights reserved. Molecular Epidemiological Investigation of Porcine kobuvirus and Its Coinfection Rate with PEDV and SaV in Northwest China Mon, 16 May 2016 13:58:40 +0000 Porcine kobuvirus (PKV) has circulated throughout China in recent years. Although many studies have detected it throughout the world, its molecular epidemiology has not been characterized in northwest China. To understand its prevalence, 203 fecal samples were collected from different regions of Gansu Province and tested with reverse transcription-polymerase chain reaction. In this study, we tested these samples for PKV, porcine epidemic diarrhea virus (PEDV), and sapovirus and analyzed the amplified 2C gene fragments of PKV. Overall, 126 (62.1%) samples were positive for PKV. Of the 74 piglets samples among the 203 fecal samples, 65 (87.8%) were positive for PKV. PKV infection was often accompanied by PEDV, but the relationship between the two viruses must be confirmed. A phylogenetic analysis indicated that the PKV strains isolated from the same regions clustered on the same branches. This investigation shows that PKV infections are highly prevalent in pigs in northwest China, especially in piglets with symptoms of diarrhea. Chen Wang, Xi Lan, and Bin Yang Copyright © 2016 Chen Wang et al. All rights reserved. Herpes Simplex Virus Type 1 and Type 2 Infection Increases Atherosclerosis Risk: Evidence Based on a Meta-Analysis Tue, 19 Apr 2016 13:33:46 +0000 Objective. The aim of our study was to evaluate the relation of herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) infection with the risk of atherosclerosis (AS). Methods. A systematic literature search was performed through three electronic databases. The pooled odds ratio (OR) and corresponding 95% confidence interval (CI) were used to assess the effect of HSV-1 and HSV-2 infection on AS risk. Results. 17 studies were available for meta-analysis of HSV-1 infection and AS risk and seven studies for meta-analysis of HSV-2 infection and AS risk. Subjects exposed to HSV-1 infection exhibited an increased risk of AS (OR = 1.77; 95% CI: 1.40–2.23; ). And consistent elevated AS risks for HSV-1 positive subjects were found in all subgroup analysis of disease type, region, male proportion, and age. HSV-2 positive subjects demonstrated significantly increased AS risk (OR = 1.37; 95% CI: 1.13–1.67; ). In subgroup analysis, elevated AS risks were only observed in myocardial ischemia group, male proportion >60% group, and age ≤60-year-old group. Conclusion. Our meta-analysis indicated that HSV-1 and HSV-2 infection could increase the risk of contracting AS. Yu peng Wu, Dan dan Sun, Yun Wang, Wen Liu, and Jun Yang Copyright © 2016 Yu peng Wu et al. All rights reserved. Chlamydia trachomatis Infection in Pregnancy: The Global Challenge of Preventing Adverse Pregnancy and Infant Outcomes in Sub-Saharan Africa and Asia Wed, 06 Apr 2016 12:45:32 +0000 Screening and treatment of sexually transmitted infections (STIs) in pregnancy represents an overlooked opportunity to improve the health outcomes of women and infants worldwide. Although Chlamydia trachomatis is the most common treatable bacterial STI, few countries have routine pregnancy screening and treatment programs. We reviewed the current literature surrounding Chlamydia trachomatis in pregnancy, particularly focusing on countries in sub-Saharan Africa and Asia. We discuss possible chlamydial adverse pregnancy and infant health outcomes (miscarriage, stillbirth, ectopic pregnancy, preterm birth, neonatal conjunctivitis, neonatal pneumonia, and other potential effects including HIV perinatal transmission) and review studies of chlamydial screening and treatment in pregnancy, while simultaneously highlighting research from resource-limited countries in sub-Saharan Africa and Asia. Kristina Adachi, Karin Nielsen-Saines, and Jeffrey D. Klausner Copyright © 2016 Kristina Adachi et al. All rights reserved. Call to Action for Nurses/Nursing Wed, 06 Apr 2016 08:30:23 +0000 The 13 million nurses worldwide constitute most of the global healthcare workforce and are uniquely positioned to engage with others to address disparities in healthcare to achieve the goal of better health for all. A new vision for nurses involves active participation and collaboration with international colleagues across research practice and policy domains. Nursing can embrace new concepts and a new approach—“One World, One Health”—to animate nursing engagement in global health, as it is uniquely positioned to participate in novel ways to improve healthcare for the well-being of the global community. This opinion paper takes a historical and reflective approach to inform and inspire nurses to engage in global health practice, research, and policy to achieve the Sustainable Development Goals. It can be argued that a colonial perspective currently informs scholarship pertaining to nursing global health engagement. The notion of unidirectional relationships where those with resources support training of those less fortunate has dominated the framing of nursing involvement in low- and middle-income countries. This paper suggests moving beyond this conceptualization to a more collaborative and equitable approach that positions nurses as cocreators and brokers of knowledge. We propose two concepts, reverse innovation and two-way learning, to guide global partnerships where nurses are active participants. Shahirose S. Premji and Jennifer Hatfield Copyright © 2016 Shahirose S. Premji and Jennifer Hatfield. All rights reserved. Acceptability and Feasibility of Sexually Transmitted Infection Testing and Treatment among Pregnant Women in Gaborone, Botswana, 2015 Mon, 28 Mar 2016 06:30:17 +0000 Introduction. Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis (TV) are curable sexually transmitted infections (STIs) that can cause adverse maternal and birth outcomes. Most countries do not conduct routine testing during antenatal care. We present data on the acceptability and feasibility of testing and treating pregnant women for STIs in an antenatal clinic in Gaborone, Botswana. Materials and Methods. We offered CT, NG, and TV testing using self-collected vaginal swabs to eligible pregnant women. Participants received same-day test results. Those who tested positive were given treatment. Results. Among the 225 women who were eligible and recruited, 200 (89%) agreed to participate. The median age of our study sample was 30 years; most were unmarried (77%), with a median gestational age of 27 weeks and a 23% HIV prevalence. All participants received their results with at least 72% () on the same day. Thirty participants (15%) tested positive for an STI, all were treated, and 24 (80%) were treated on the same day. Conclusion. The acceptability of STI testing was high, and the intervention was feasible. This study provides support for continued research into STI prevalence, cost-effectiveness, and the association of STIs with adverse maternal and infant outcomes. Adriane Wynn, Doreen Ramogola-Masire, Ponatshego Gaolebale, Neo Moshashane, Ogechukwu Agatha Offorjebe, Kaitlin Arena, Jeffrey D. Klausner, and Chelsea Morroni Copyright © 2016 Adriane Wynn et al. All rights reserved. Prenatal Evaluation of MicroRNA Expressions in Pregnancies with Down Syndrome Thu, 24 Mar 2016 08:46:17 +0000 Background. Currently, the data available on the utility of miRNAs in noninvasive prenatal testing is insufficient in the literature. We evaluated the expression levels of 14 miRNAs located on chromosome 21 in maternal plasma and their utility in noninvasive prenatal testing of Down Syndrome. Method. A total of 56 patients underwent invasive prenatal testing; 23 cases were carrying Down Syndrome affected fetuses, and 33 control cases carrying unaffected, normal karyotype fetuses were included for comparison. Indications for invasive prenatal testing were advanced maternal age, increased risk of Down Syndrome in screening tests, and abnormal finding in the sonographic examination. In both the study and control groups, all the pregnant women were at 17th and 18th week of gestation. miRNA expression levels were measured using real-time RT-PCR. Results. Significantly increased maternal plasma levels of miR-3156 and miR-99a were found in the women carrying a fetus with Down Syndrome. Conclusion. Our results provide a basis for multicenter studies with larger sample groups and microRNA profiles, particularly with the microRNAs which were found to be variably expressed in our study. Through this clinical research, the utility of microRNAs in noninvasive prenatal testing can be better explored in future studies. Biray Erturk, Emin Karaca, Ayca Aykut, Burak Durmaz, Ahmet Guler, Baris Buke, Ahmet Ozgur Yeniel, Ahmet Mete Ergenoglu, Ferda Ozkinay, Mehmet Ozeren, Mert Kazandi, Fuat Akercan, Sermet Sagol, Cumhur Gunduz, and Ozgur Cogulu Copyright © 2016 Biray Erturk et al. All rights reserved. “I Always Worry about What Might Happen Ahead”: Implementing Safer Conception Services in the Current Environment of Reproductive Counseling for HIV-Affected Men and Women in Uganda Tue, 08 Mar 2016 07:11:10 +0000 Background. We explored healthcare provider perspectives and practices regarding safer conception counseling for HIV-affected clients. Methods. We conducted semistructured interviews with 38 providers (medical and clinical officers, nurses, peer counselors, and village health workers) delivering care to HIV-infected clients across 5 healthcare centres in Mbarara District, Uganda. Interview transcripts were analyzed using content analysis. Results. Of 38 providers, 76% were women with median age 34 years (range 24–57). First, we discuss providers’ reproductive counseling practices. Emergent themes include that providers (1) assess reproductive goals of HIV-infected female clients frequently, but infrequently for male clients; (2) offer counseling focused on “family planning” and maternal and child health; (3) empathize with the importance of having children for HIV-affected clients; and (4) describe opportunities to counsel HIV-serodiscordant couples. Second, we discuss provider-level challenges that impede safer conception counseling. Emergent themes included the following: (1) providers struggle to translate reproductive rights language into individualized risk reduction given concerns about maternal health and HIV transmission and (2) providers lack safer conception training and support needed to provide counseling. Discussion. Tailored guidelines and training are required for providers to implement safer conception counseling. Such support must respond to provider experiences with adverse HIV-related maternal and child outcomes and a national emphasis on pregnancy prevention. Lynn T. Matthews, Francis Bajunirwe, Jasmine Kastner, Naomi Sanyu, Cecilia Akatukwasa, Courtney Ng, Rachel Rifkin, Cecilia Milford, Lizzie Moore, Ira B. Wilson, David R. Bangsberg, Jennifer A. Smit, and Angela Kaida Copyright © 2016 Lynn T. Matthews et al. All rights reserved. Associations of Genetic Variants at Nongenic Susceptibility Loci with Breast Cancer Risk and Heterogeneity by Tumor Subtype in Southern Han Chinese Women Sun, 28 Feb 2016 14:27:53 +0000 Current understanding of cancer genomes is mainly “gene centric.” However, GWAS have identified some nongenic breast cancer susceptibility loci. Validation studies showed inconsistent results among different populations. To further explore this inconsistency and to investigate associations by intrinsic subtype (Luminal-A, Luminal-B, ER−&PR−&HER2+, and triple negative) among Southern Han Chinese women, we genotyped five nongenic polymorphisms (2q35: rs13387042, 5p12: rs981782 and rs4415084, and 8q24: rs1562430 and rs13281615) using MassARRAY IPLEX platform in 609 patients and 882 controls. Significant associations with breast cancer were observed for rs13387042 and rs4415084 with OR (95% CI) per-allele 1.29 (1.00–1.66) and 0.83 (0.71–0.97), respectively. In subtype specific analysis, rs13387042 (per-allele adjusted OR = 1.36, 95% CI = 1.00–1.87) and rs4415084 (per-allele adjusted OR = 0.82, 95% CI = 0.66–1.00) showed slightly significant association with Luminal-A subtype; however, only rs13387042 was associated with ER−&PR−&HER2+ tumors (per-allele adjusted OR = 1.55, 95% CI = 1.00–2.40), and none of them were linked to Luminal-B and triple negative subtype. Collectively, nongenic SNPs were heterogeneous according to the intrinsic subtype. Further studies with larger datasets along with intrinsic subtype categorization should explore and confirm the role of these variants in increasing breast cancer risk. Huiying Liang, Hong Li, Xuexi Yang, Lujia Chen, Anna Zhu, Minying Sun, Changsheng Ye, and Ming Li Copyright © 2016 Huiying Liang et al. All rights reserved. Mathematical Model for an Effective Management of HIV Infection Sun, 28 Feb 2016 07:25:11 +0000 Human immunodeficiency virus infection destroys the body immune system, increases the risk of certain pathologies, damages body organs such as the brain, kidney, and heart, and causes death. Unfortunately, this infectious disease currently has no cure; however, there are effective retroviral drugs for improving the patients’ health conditions but excessive use of these drugs is not without harmful side effects. This study presents a mathematical model with two control variables, where the uninfected CD4+T cells follow the logistic growth function and the incidence term is saturated with free virions. We use the efficacy of drug therapies to block the infection of new cells and prevent the production of new free virions. Our aim is to apply optimal control approach to maximize the concentration of uninfected CD4+T cells in the body by using minimum drug therapies. We establish the existence of an optimal control pair and use Pontryagin’s principle to characterize the optimal levels of the two controls. The resulting optimality system is solved numerically to obtain the optimal control pair. Finally, we discuss the numerical simulation results which confirm the effectiveness of the model. Oladotun Matthew Ogunlaran and Suares Clovis Oukouomi Noutchie Copyright © 2016 Oladotun Matthew Ogunlaran and Suares Clovis Oukouomi Noutchie. All rights reserved. Evaluating Religious Influences on the Utilization of Maternal Health Services among Muslim and Christian Women in North-Central Nigeria Wed, 24 Feb 2016 09:41:55 +0000 Introduction. Uptake of antenatal services is low in Nigeria; however, indicators in the Christian-dominated South have been better than in the Muslim-dominated North. This study evaluated religious influences on utilization of general and HIV-related maternal health services among women in rural and periurban North-Central Nigeria. Materials and Methods. Targeted participants were HIV-positive, pregnant, or of reproductive age in the Federal Capital Territory and Nasarawa. Themes explored were utilization of facility-based services, provider gender preferences, and Mentor Mother acceptability. Thematic and content approaches were applied to manual data analysis. Results. Sixty-eight (68) women were recruited, 72% Christian and 28% Muslim. There were no significant religious influences identified among barriers to maternal service uptake. All participants stated preference for facility-based services. Uptake limitations were mainly distance from clinic and socioeconomic dependence on male partners rather than religious restrictions. Neither Muslim nor Christian women had provider gender preferences; competence and positive attitude were more important. All women found Mentor Mothers highly acceptable. Conclusion. Barriers to uptake of maternal health services appear to be minimally influenced by religion. ANC/PMTCT uptake interventions should target male partner buy-in and support, healthcare provider training to improve attitudes, and Mentor Mother program strengthening and impact assessment. Maryam Al-Mujtaba, Llewellyn J. Cornelius, Hadiza Galadanci, Salome Erekaha, Joshua N. Okundaye, Olusegun A. Adeyemi, and Nadia A. Sam-Agudu Copyright © 2016 Maryam Al-Mujtaba et al. All rights reserved. Coxiella burnetii Seroprevalence and Risk Factors in Cattle Farmers and Farm Residents in Three Northeastern Provinces and Inner Mongolia Autonomous Region, China Thu, 04 Feb 2016 13:32:47 +0000 Little is known about Coxiella burnetii infection among cattle farmers and farm residents in China. Thus, the present study was conducted to detect the seroprevalence of C. burnetii infection and estimate associated risk factors among cattle farmers and farm residents in China. A cross-sectional study was designed, and sera of 362 people living or working on 106 cattle farms were tested for C. burnetii IgG and IgM antibodies by immunofluorescence assay. Overall C. burnetii seroprevalence was 35.6% (129/362, 95% CI: 30.70–40.57), and 112 participants had experienced a past infection and seventeen (4.7%) had experienced a relatively recent infection. In the final combined multilevel model, the following activities were significantly associated with presence of antibodies against C. burnetii: milking cattle, providing general healthcare to cattle, providing birth assistance, contact dead-born animals, urbanization, and presence of mice and/or rats in the stable. Moreover, presence of disinfection equipment was a significant protective factor. This is the first study addressing the seroprevalence and risk factors of C. burnetii infection in cattle farmers and farm residents in three northeastern provinces and Inner Mongolia Autonomous Region, China. Wu-Wen Sun, Wei Cong, Mao-Hui Li, Chun-Feng Wang, Xiao-Feng Shan, and Ai-Dong Qian Copyright © 2016 Wu-Wen Sun et al. All rights reserved. Status of Human Papillomavirus Infection in the Ethnic Population in Yunnan Province, China Sun, 27 Dec 2015 13:52:39 +0000 HPV genotypes have distinct distributions among various ethnic populations worldwide. In December 2013, 237 and 159 cervical samples were collected from Hani and Han ethnic women, respectively, in Mojiang, a rural county in southern Yunnan. The overall HPV infection rate (21.1%) among the Hani women was significantly higher than that among the Han women (12.6%). The high-risk (HR) and low-risk (LR) HPV and single- and multiple-genotype infection rates among the Hani women were 11.0%, 4.6%, 15.6%, and 5.5%, respectively. HPV-16 (3.8%) was the most prevalent genotype among the Hani women, followed by HPV-52 (1.7%), HPV-31 (0.8%), and HPV-33 (0.8%). Comparatively, the Han women had lower infection rates of high-risk (8.2%), low-risk (1.2%), single-genotype (9.4%), and multiple-genotype HPV infections (3.1%). HPV-16 (3.1%) was also the predominant genotype among the Han women, followed by HPV-52 (1.3%), HPV-33 (0.6%), HPV-44 (0.6%), and HPV-54 (0.6%). The area background, number of children, and past history of STIs were recognized as potential risk factors for HPV infection. Rural background, age, education level, number of children, and illness history were significantly associated with HPV infection among the Hani women. These findings highlight the urgent need for HPV prevention and control strategies in Yunnan, particularly for the Hani ethnic women. Zulqarnain Baloch, Lei Yue, Tao Yuan, Yue Feng, Wenlin Tai, Yanqing Liu, Binghui Wang, Xiao Li, Li Liu, A-Mei Zhang, Xiaomei Wu, and Xueshan Xia Copyright © 2015 Zulqarnain Baloch et al. All rights reserved. Temporal Trends and Predictors of Modern Contraceptive Use in Lusaka, Zambia, 2004–2011 Sun, 27 Dec 2015 09:20:01 +0000 Introduction. Although increasing access to family planning has been an important part of the global development agenda, millions of women continue to face unmet need for contraception. Materials and Methods. We analyzed data from a repeated cross-sectional community survey conducted in Lusaka, Zambia, over an eight-year period. We described prevalence of modern contraceptive use, including long-acting reversible contraception (LARC), among female heads of household aged 16–50 years. We also identified predictors of LARC versus short-term contraceptive use among women using modern methods. Results and Discussion. Twelve survey rounds were completed between November 2004 and September 2011. Among 29,476 eligible respondents, 17,605 (60%) reported using modern contraception. Oral contraceptive pills remained the most popular method over time, but use of LARC increased significantly, from less than 1% in 2004 to 9% by 2011 (). Younger women (OR: 0.46, 95% CI: 0.34, 0.61) and women with lower levels of education (OR: 0.70, 95% CI: 0.56, 0.89) were less likely to report LARC use compared to women using short-term modern methods. Conclusions. Population-based assessments of contraceptive use over time can guide programs and policies. To achieve reproductive health equity and reduce unmet contraceptive need, future efforts to increase LARC use should focus on young women and those with less education. Nancy L. Hancock, Carla J. Chibwesha, Marie C. D. Stoner, Bellington Vwalika, Sujit D. Rathod, Margaret Phiri Kasaro, Elizabeth M. Stringer, Jeffrey S. A. Stringer, and Benjamin H. Chi Copyright © 2015 Nancy L. Hancock et al. All rights reserved. Structural Determinants in Family Planning Service Utilization in Ethiopia: EDHS 2011 Analysis Wed, 09 Dec 2015 07:42:44 +0000 Family planning coverage has improved in Ethiopia in the last decade, though fertility is still about 5.8 in the rural setup. In this paper, the major structural determinants of family planning service were analyzed using a multilevel model from 8906 individual women observation in the 2011 EDHS data. The results show that there is a big variation in family planning use both at the individual and between group levels. More than 39% of the variation in FP use is explained by contextual cluster level differences. Most of the socioeconomic predictors; respondent’s education, ethnicity, and partners’ education as well as employment status and urbanization were found to be significant factors that affect FP use. Similarly health extension visit and media access were found to be strong factors that affect FP service at both individual and cluster levels. This evidence concludes that addressing these contextual factors is very crucial to strengthen FP use and fertility reduction in the nation, beyond individual behavioral changes. Jembere Gizachew Balew, Yongtae Cho, Clara Tammy Kim, and Woorim Ko Copyright © 2015 Jembere Gizachew Balew et al. All rights reserved. Polycyclic Aromatic Hydrocarbons Concentrations in Drinking Water in Villages along the Huai River in China and Their Association with High Cancer Incidence in Local Population Tue, 24 Nov 2015 09:46:24 +0000 This study aims to evaluate the carcinogenic risk of PAHs in the drinking water of counties along the Huai River in China and study their associations with high cancer incidence in local population. We investigated 20 villages with high cancer incidence rates as the risk group and 20 villages with low rates as the control group. Water samples from each village were collected in the winter and summer seasons to analyze the concentrations of 16 PAHs. The carcinogenic risks of the PAHs were calculated for each village using a health risk assessment approach. Results showed that PAHs concentrations in 27.2% of the water samples were higher than the allowable values in China. However, no significant difference in water PAHs concentrations was observed between the risk and control groups (), and no correlation was found between water PAHs concentrations and cancer incidence in these villages. The average upper bound carcinogenic risks were less than in both groups. In conclusion, PAHs were present in the drinking water of the studied villages, but their carcinogenic risks remained within acceptable limits. PAHs in local drinking water might not be the major environmental cause of the high cancer incidences. En chun Pan, Hong Sun, Qiu jin Xu, Qin Zhang, Lin fei Liu, Xiao dong Chen, and Yan Xu Copyright © 2015 En chun Pan et al. All rights reserved. Predicting 30-Day Readmissions: Performance of the LACE Index Compared with a Regression Model among General Medicine Patients in Singapore Mon, 23 Nov 2015 16:01:45 +0000 The LACE index (length of stay, acuity of admission, Charlson comorbidity index, CCI, and number of emergency department visits in preceding 6 months) derived in Canada is simple and may have clinical utility in Singapore to predict readmission risk. We compared the performance of the LACE index with a derived model in identifying 30-day readmissions from a population of general medicine patients in Singapore. Additional variables include patient demographics, comorbidities, clinical and laboratory variables during the index admission, and prior healthcare utilization in the preceding year. 5,862 patients were analysed and 572 patients (9.8%) were readmitted in the 30 days following discharge. Age, CCI, count of surgical procedures during index admission, white cell count, serum albumin, and number of emergency department visits in previous 6 months were significantly associated with 30-day readmission risk. The final logistic regression model had fair discriminative ability c-statistic of 0.650 while the LACE index achieved c-statistic of 0.628 in predicting 30-day readmissions. Our derived model has the advantage of being available early in the admission to identify patients at high risk of readmission for interventions. Additional factors predicting readmission risk and machine learning techniques should be considered to improve model performance. Lian Leng Low, Kheng Hock Lee, Marcus Eng Hock Ong, Sijia Wang, Shu Yun Tan, Julian Thumboo, and Nan Liu Copyright © 2015 Lian Leng Low et al. All rights reserved. Toxoplasma gondii Infection in Pregnant Women: A Seroprevalence and Case-Control Study in Eastern China Sun, 11 Oct 2015 08:06:07 +0000 Very limited information is available concerning the epidemiology of T. gondii infection in pregnant women in eastern China. Therefore, a case-control study was conducted to estimate the seroprevalence of toxoplasmosis in this population group and to identify risk factors and possible routes of contamination. Serum samples were collected from 965 pregnant women and 965 age-matched nonpregnant control subjects in Qingdao and Weihai between October 2011 and July 2013. These were screened with enzyme linked immunoassays for the presence of anti-Toxoplasma IgG and anti-Toxoplasma IgM antibodies. 147 (15.2%) pregnant women and 167 (17.3%) control subjects were positive for anti-T. gondii IgG antibodies, while 28 (2.9%) pregnant women and 37 (3.8%) controls were positive for anti-T. gondii IgM antibodies (). There was no significant difference between pregnant women and nonpregnant controls with regard to the seroprevalence of either anti-T. gondii IgG or IgM antibodies. Multivariate analysis showed that T. gondii infection was associated with location, cats in home, contact with cats and dogs, and exposure to soil. The results indicated that the seroprevalence of T. gondii infection in pregnant women is high compared to most other regions of China and other East Asian countries with similar climatic conditions. Wei Cong, Xiao-Yan Dong, Qing-Feng Meng, Na Zhou, Xiang-Yang Wang, Si-Yang Huang, Xing-Quan Zhu, and Ai-Dong Qian Copyright © 2015 Wei Cong et al. All rights reserved. Colorectal Cancer: Advances in Prevention and Early Detection Wed, 07 Oct 2015 12:15:53 +0000 Anne Miles, Fränzel van Duijnhoven, Amy McQueen, and Raymond Oliphant Copyright © 2015 Anne Miles et al. All rights reserved. Piloting the Impact of Three Interventions on Guaiac Faecal Occult Blood Test Uptake within the NHS Bowel Cancer Screening Programme Wed, 07 Oct 2015 09:16:12 +0000 This study evaluated the impact of three interventions on uptake of the guaiac faecal occult blood test (gFOBT) in Greater London. The interventions were designed to improve awareness and understanding of the NHS Bowel Cancer Screening Programme (BCSP) and assist stool sampling. Logistic regression analysis of BCSP London data ( invitees aged 60–74) compared uptake at 12 weeks between intervention groups and a control group, sent kits as usual between January-April 2013 and January-April 2014. An endorsement flyer, included with gFOBT kits, had no impact on uptake (). In 60–69-year-olds, there was a small but significant increase in modelled uptake amongst invitees sent both the flyer and a kit enhancement pack compared with controls (45.1% versus 43.4%, , ). In North East London, the flyer together with outdoor advertising was associated with a small but significant increase (45.6% versus 43.4%, , ). The largest increases were seen when all three interventions (flyer, pack, and advertising) were combined (49.5% versus 43.4%, , ). The increased uptake in the intervention groups was largest in “first-timers” and smaller amongst previous nonresponders and previously screened invitees. Becky White, Emily Power, Monika Ciurej, Siu Hing Lo, Katherine Nash, and Nick Ormiston-Smith Copyright © 2015 Becky White et al. All rights reserved. A Media and Clinic Intervention to Increase Colorectal Cancer Screening in Ohio Appalachia Mon, 05 Oct 2015 09:36:41 +0000 Objective. To test the effectiveness of a colorectal cancer (CRC) screening intervention among adults living in Ohio Appalachia. Methods. We conducted a group-randomized trial of a county-level intervention among adults living in 12 Ohio Appalachian counties who received a media campaign and clinic intervention focused on either CRC screening or fruits and vegetables. Participants’ percentage within CRC screening guidelines was assessed with cross-sectional surveys conducted annually for four years, and validated with medical record review of screening. Results. On average, screening data were obtained on 564 intervention and 559 comparison participants per year. There was no difference in the Wave 4 CRC screening rates of intervention and comparison counties (35.2% versus 31.4%). Multivariate analyses found that high perceived risk of CRC, willingness to have a CRC test if recommended by a doctor, doctor recommendation of a CRC screening test, and patient-physician communication about changes in bowel habits, family history of CRC, and eating fruits and vegetables were significant () predictors of being within CRC screening guidelines. Conclusions. The intervention was not effective in increasing CRC rates among Ohio Appalachian adults. Future research should determine how media and clinic-based interventions can be modified to improve CRC screening rates among this underserved population. Jessica L. Krok-Schoen, Mira L. Katz, Jill M. Oliveri, Gregory S. Young, Michael L. Pennell, Paul L. Reiter, Jesse J. Plascak, Michael D. Slater, Janice L. Krieger, Cathy M. Tatum, and Electra D. Paskett Copyright © 2015 Jessica L. Krok-Schoen et al. All rights reserved. Pathologic Assessment of Rectal Carcinoma after Neoadjuvant Radio(chemo)therapy: Prognostic Implications Mon, 05 Oct 2015 08:10:42 +0000 Neoadjuvant radio(chemo)therapy is increasingly used in rectal cancer and induces a number of morphologic changes that affect prognostication after curative surgery, thereby creating new challenges for surgical pathologists, particularly in evaluating morphologic changes and tumour response to preoperative treatment. Surgical pathologists play an important role in determining the many facets of rectal carcinoma patient care after neoadjuvant treatment. These range from proper handling of macroscopic specimens to accurate microscopic evaluation of pathological features associated with patients’ prognosis. This review presents the well-established pathological prognostic indicators and discusses challenging features in order to provide both surgical pathologists and treating physicians with a checklist that is useful in a neoadjuvant setting. Monirath Hav, Louis Libbrecht, Liesbeth Ferdinande, Karen Geboes, Piet Pattyn, and Claude A. Cuvelier Copyright © 2015 Monirath Hav et al. All rights reserved. Mycobacterium avium Subspecies paratuberculosis and Bovine Leukemia Virus Seroprevalence and Associated Risk Factors in Commercial Dairy and Beef Cattle in Northern and Northeastern China Sun, 04 Oct 2015 14:30:46 +0000 Mycobacterium avium subspecies paratuberculosis (MAP) and bovine leukemia virus (BLV) are important pathogens, commonly responsible for economical loss to cattle farms all over the world, yet their epidemiology in commercial dairy and beef cattle in China is still unknown. Thus, from September 2013 to December 2014, a large-scale seroprevalence study was conducted to determine the seroprevalence and identify herd-level risk factors associated with MAP and BLV infection. The source sample was 3674 cattle from 113 herds in northern and northeastern China. Antibodies against MAP and BLV were detected using ELISA tests. At animal-level, the seroprevalence of antibodies against MAP and BLV was 11.79% (433/3674) and 18.29% (672/3674), respectively. At herd-level, the seroprevalence of antibodies against MAP and BLV was 20.35% and 21.24% (24/113), respectively. Herd size was identified to be associated with MAP infection while herd size and presence of cattle introduced from other farms were significantly associated with BLV infection. Further research is needed to confirm these findings and improve the knowledge of the epidemiology of these two pathogens in these regions and elsewhere in China. Wu-Wen Sun, Wen-Fa Lv, Wei Cong, Qing-Feng Meng, Chun-Feng Wang, Xiao-Feng Shan, and Ai-Dong Qian Copyright © 2015 Wu-Wen Sun et al. All rights reserved. Awareness of Lifestyle and Colorectal Cancer Risk: Findings from the BeWEL Study Sun, 04 Oct 2015 14:04:00 +0000 It is estimated that 47% of colorectal cancers (CRC) could be prevented by appropriate lifestyles. This study aimed to identify awareness of the causes of CRC in patients who had been diagnosed with a colorectal adenoma through the Scottish Bowel Screening Programme and subsequently enrolled in an intervention trial (using diet and physical activity education and behavioural change techniques) (BeWEL). At baseline and 12-month follow-up, participants answered an open-ended question on factors influencing CRC development. Of the 329 participants at baseline, 40 (12%) reported that they did not know any risk factors and 36 (11%) failed to identify specific factors related to diet and activity. From a potential knowledge score of 1 to 6, the mean score was 1.5 (SD 1.1, range 0 to 5) with no difference between intervention and control groups. At follow-up, the intervention group had a significantly greater knowledge score and better weight loss, diet, and physical activity measures than the control group. Awareness of relevant lifestyle factors for CRC remains low in people at increased risk of the disease. Opportunities within routine NHS screening to aid the capability (including knowledge of risk factors) of individuals to make behavioural changes to reduce CRC risk deserve exploration. Annie S. Anderson, Stephen Caswell, Maureen Macleod, Angela M. Craigie, Martine Stead, Robert J. C. Steele, and The BeWEL Team Copyright © 2015 Annie S. Anderson et al. All rights reserved. The Relationship between Neighborhood Immigrant Composition, Limited English Proficiency, and Late-Stage Colorectal Cancer Diagnosis in California Sun, 04 Oct 2015 13:25:01 +0000 Despite the availability of effective early detection technologies, more than half (61%) of colorectal cancers in the United States and 55% in California are identified at an advanced stage. Data on colorectal cancer patients (,030) diagnosed from 2005 to 2007 were obtained from the California Cancer Registry. Multivariate analyses found a relationship among neighborhood concentration of recent immigrants, neighborhood rates of limited English proficiency, and late-stage colorectal cancer diagnosis. Hispanics living in neighborhoods with a greater percentage of recent immigrants (compared to the lowest percentage) had greater odds (OR 1.57, 95% CI 1.22, 2.02) of late-stage diagnosis whereas Hispanics living in neighborhoods with the highest percentage of limited English proficiency (compared to the lowest percentage) had lower odds (OR .71, 95% CI .51, .99) of late-stage diagnosis. These relationships were not observed for other ethnic groups. Results highlight the complex relationship among race/ethnicity, neighborhood characteristics, and colorectal cancer stage at diagnosis. Cynthia M. Mojica, Beth A. Glenn, Cindy Chang, and Roshan Bastani Copyright © 2015 Cynthia M. Mojica et al. All rights reserved. Missed Opportunities for the Diagnosis of Colorectal Cancer Sun, 04 Oct 2015 10:20:02 +0000 Objective. To examine patient and medical characteristics which predict a missed diagnostic opportunity (MDO) for colorectal cancer (CRC). Methods. The sample consisted of 252 patients diagnosed with Stages 1–4 CRC who were diagnosed in the prior six months, had experienced symptoms prior to diagnosis, and were not diagnosed through routine screening. Systematic review of all medical records prior to patients’ diagnosis was conducted. An MDO was defined as a clinical encounter where, even in the presence of presumptive CRC symptoms, the CRC diagnostic process is not started. Results. 92 patients (36.5%) experienced an MDO. Almost 80% of alternate diagnoses were other GI-GU diseases, including hemorrhoids and diverticulitis. Stomach pain, anemia, and constipation were the most common symptoms experienced by the MDO group. These symptoms, and weight loss and vomiting, were more likely to be noted in the charts of the MDO patients (). Independent risk factors for MDO included age (<50) [OR = 2.29 (1.14–4.60), ] and female sex [OR = 2.19 (1.16–4.16), ]. Each additional physician seen, more than doubled the MDO risk [OR = 2.05 (1.53–2.74), ]. Conclusions. Females, younger patients, and those consulting more physicians were all more likely to experience an MDO. Continued increased training of physicians to enhance knowledge of who is vulnerable to CRC is needed in addition to an increased focus to adherence to screening recommendations. Laura A. Siminoff, Heather L. Rogers, and Sonja Harris-Haywood Copyright © 2015 Laura A. Siminoff et al. All rights reserved. Developments in Screening Tests and Strategies for Colorectal Cancer Sun, 04 Oct 2015 09:26:52 +0000 Background. Worldwide, colorectal cancer (CRC) is the third most common cancer in men and second most common in women. It is the fourth most common cause of cancer mortality. In the United States, CRC is the third most common cause of cancer and second most common cause of cancer mortality. Incidence and mortality rates have steadily fallen, primarily due to widespread screening. Methods. We conducted keyword searches on PubMed in four categories of CRC screening: stool, endoscopic, radiologic, and serum, as well as news searches in Medscape and Google News. Results. Colonoscopy is the gold standard for CRC screening and the most common method in the United States. Technological improvements continue to be made, including the promising “third-eye retroscope.” Fecal occult blood remains widely used, particularly outside the United States. The first at-home screen, a fecal DNA screen, has also recently been approved. Radiological methods are effective but seldom used due to cost and other factors. Serum tests are largely experimental, although at least one is moving closer to market. Conclusions. Colonoscopy is likely to remain the most popular screening modality for the immediate future, although its shortcomings will continue to spur innovation in a variety of modalities. Justin L. Sovich, Zachary Sartor, and Subhasis Misra Copyright © 2015 Justin L. Sovich et al. All rights reserved. Social Cognitive Mediators of Sociodemographic Differences in Colorectal Cancer Screening Uptake Sun, 04 Oct 2015 09:18:25 +0000 Background. This study examined if and how sociodemographic differences in colorectal cancer (CRC) screening uptake can be explained by social cognitive factors. Methods. Face-to-face interviews were conducted with individuals aged 60–70 years () living in England as part of a population-based omnibus survey. Results. There were differences in screening uptake by SES, marital status, ethnicity, and age but not by gender. Perceived barriers (stand. , ), social norms (stand. , ), and screening knowledge (stand. , ) had independent associations with uptake. SES differences in uptake were mediated through knowledge, social norms, and perceived barriers. Ethnic differences were mediated through knowledge. Differences in uptake by marital status were primarily mediated through social norms and to a lesser extent through knowledge. Age differences were largely unmediated, except for a small mediated effect via social norms. Conclusions. Sociodemographic differences in CRC screening uptake were largely mediated through social cognitive factors. Impact. Our findings suggest that multifaceted interventions might be needed to reduce socioeconomic inequalities. Ethnic differences might be reduced through improved screening knowledge. Normative interventions could emphasise screening as an activity endorsed by important others outside the immediate family to appeal to a wider audience. Siu Hing Lo, Jo Waller, Charlotte Vrinten, Lindsay Kobayashi, and Christian von Wagner Copyright © 2015 Siu Hing Lo et al. All rights reserved. Breast Cancer by Age at Diagnosis in the Gharbiah, Egypt, Population-Based Registry Compared to the United States Surveillance, Epidemiology, and End Results Program, 2004–2008 Thu, 01 Oct 2015 07:00:55 +0000 Objective. Although breast cancers (BCs) in young women often display more aggressive features, younger women are generally not screened for early detection. It is important to understand the characteristics of young onset breast cancer to increase awareness in this population. This analysis includes all ages, with emphasis placed on younger onset BC in Egypt as compared to the United States. Methods. BC cases in the Gharbiah cancer registry (GCR), Egypt, were compared to those in the Surveillance, Epidemiology, and End Results (SEER) database. This analysis included 3,819 cases from the GCR and 273,019 from SEER diagnosed 2004–2008. Results. GCR cases were diagnosed at later stages, with <5% diagnosed at Stage I and 12% diagnosed at Stage IV. 48% of all SEER cases were diagnosed at Stage I, dropping to 30% among those ≤40. Significant differences in age, tumor grade, hormone receptor status, histology, and stage exist between GCR and SEER BCs. After adjustment, GCR cases were nearly 45 times more likely to be diagnosed at stage III and 16 times more likely to be diagnosed at stage IV than SEER cases. Conclusions. Future research should examine ways to increase literacy about early detection and prompt therapy in young cases. Jennifer A. Schlichting, Amr S. Soliman, Catherine Schairer, Joe B. Harford, Ahmed Hablas, Mohamed Ramadan, Ibrahim Seifeldin, and Sofia D. Merajver Copyright © 2015 Jennifer A. Schlichting et al. All rights reserved. Following Up Crack Users after Hospital Discharge Using Record Linkage Methodology: An Alternative to Find Hidden Populations Sun, 06 Sep 2015 09:58:14 +0000 This paper presents the probabilistic record linkage (PRL) methodology as an alternative way to find or follow up hard-to-reach population as crack users. PRL was based on secondary data from public health information systems and the strategy used from standardization; phonetic encoding and the rounds of matching data were described. A total of 293 patient records from medical database and two administrative datasets obtained from Ministry of Health Information Systems were used. Patient information from the medical database was the identifiers to the administrative datasets containing data on outpatient treatment and hospital admissions. 40% of patient records were found in the hospital database and 12% were found in the outpatient database; 95% of the patients were hospitalized up to 5 times, and only 10 out of them had outpatient information. The record linkage methodology by linking government databases may help to address research questions about the path of patients in the care network without spending time and financial resources with primary data collection. Veralice Maria Gonçalves, Rosemeri Pedroso, Antônio Marcos dos Santos, Lisia Von Diemen, and Flavio Pechansky Copyright © 2015 Veralice Maria Gonçalves et al. All rights reserved. Heterogeneity of Breast Cancer Associations with Common Genetic Variants in FGFR2 according to the Intrinsic Subtypes in Southern Han Chinese Women Thu, 03 Sep 2015 06:46:16 +0000 GWAS have identified variation in the FGFR2 locus as risk factors for breast cancer. Validation studies, however, have shown inconsistent results by ethnics and pathological characteristics. To further explore this inconsistency and investigate the associations of FGFR2 variants with breast cancer according to intrinsic subtype (Luminal-A, Luminal-B, ER−&PR−&HER2+, and triple negative) among Southern Han Chinese women, we genotyped rs1078806, rs1219648, rs2420946, rs2981579, and rs2981582 polymorphisms in 609 patients and 882 controls. Significant associations with breast cancer risk were observed for rs2420946, rs2981579, and rs2981582 with OR (95% CI) per risk allele of 1.19 (1.03–1.39), 1.24 (1.07–1.43), and 1.17 (1.01–1.36), respectively. In subtype specific analysis, above three SNPs were significantly associated with increased Luminal-A risk in a dose-dependent manner ; however, only rs2981579 was associated with Luminal-B, and none were linked to ER−&PR− subtypes (ER−&PR−&HER2+ and triple negative). Haplotype analyses also identified common haplotypes significantly associated with luminal-like subtypes (Luminal-A and Luminal-B), but not with ER−&PR− subtypes. Our results suggest that associations of FGFR2 SNPs with breast cancer were heterogeneous according to intrinsic subtype. Future studies stratifying patients by their intrinsic subtypes will provide new insights into the complex genetic mechanisms underlying breast cancer. Huiying Liang, Xuexi Yang, Lujia Chen, Hong Li, Anna Zhu, Minying Sun, Haitao Wang, and Ming Li Copyright © 2015 Huiying Liang et al. All rights reserved. A Population-Based Model to Consider the Effect of Seasonal Variation on Serum 25(OH)D and Vitamin D Status Tue, 01 Sep 2015 07:25:38 +0000 Background. We elaborated a model that predicts the centiles of the 25(OH)D distribution taking into account seasonal variation. Methods. Data from two Swiss population-based studies were used to generate (CoLaus) and validate (Bus Santé) the model. Serum 25(OH)D was measured by ultra high pressure LC-MS/MS and immunoassay. Linear regression models on square-root transformed 25(OH)D values were used to predict centiles of the 25(OH)D distribution. Distribution functions of the observations from the replication set predicted with the model were inspected to assess replication. Results. Overall, 4,912 and 2,537 Caucasians were included in original and replication sets, respectively. Mean (SD) 25(OH)D, age, BMI, and % of men were 47.5 (22.1) nmol/L, 49.8 (8.5) years, 25.6 (4.1) kg/m2, and 49.3% in the original study. The best model included gender, BMI, and sin-cos functions of measurement day. Sex- and BMI-specific 25(OH)D centile curves as a function of measurement date were generated. The model estimates any centile of the 25(OH)D distribution for given values of sex, BMI, and date and the quantile corresponding to a 25(OH)D measurement. Conclusions. We generated and validated centile curves of 25(OH)D in the general adult Caucasian population. These curves can help rank vitamin D centile independently of when 25(OH)D is measured. Philippe Vuistiner, Valentin Rousson, Hugues Henry, Pierre Lescuyer, Olivier Boulat, Jean-Michel Gaspoz, Vincent Mooser, Peter Vollenweider, Gerard Waeber, Jacques Cornuz, Fred Paccaud, Murielle Bochud, and Idris Guessous Copyright © 2015 Philippe Vuistiner et al. All rights reserved. Khat (Catha edulis Forsk.) Dependence Potential and Pattern of Use in Saudi Arabia Mon, 24 Aug 2015 11:39:55 +0000 Background. Catha edulis Forsk. (Khat) is used for its psychoactive effects among people in Africa and the Arabian Peninsula, although its utilization is illegal in some countries such as Saudi Arabia. This study examined the pattern of Khat use and assessed the applicability of the Drug Abuse Screening Test-10 (DAST-10) to measure Khat dependence. Methods. A pretested questionnaire was used to gather data from 603 respondents. Variables included demographic characteristics, pattern of use, reasons for Khat chewing, and DAST-10. Stepwise-logistic regression was used to explore predictors of Khat dependence. Results. The majority of the respondents were married, had a secondary school level of education, were employed, were younger than 35 years old, and were living in rural areas. Many chewers gave more than one reason for using Khat. It was mainly used to increase mental capacity, physical strength, and social entertainment, as well as enhance cheerfulness and orgasms. Statistical modeling of Khat dependence suggested that the most significant predictors were residence (OR = 1.67, ), frequency of Khat chewing (OR = 4.8, ), age of starting Khat chewing (OR = 1.15, ), and time of Khat effect (OR = 1.15, ). Conclusion. Our study provides important information on the pattern of Khat use and its potential to cause dependence. Siddig Ibrahim Abdelwahab, Rashad Mohammed Alsanosy, Bahaa-eldin E. A. Rahim, Syam Mohan, Sara Taha, Manal Mohamed Elhassan, and Maged El-Setouhy Copyright © 2015 Siddig Ibrahim Abdelwahab et al. All rights reserved. Prevalence and Genotyping of Cryptosporidium Infection in Pet Parrots in North China Sun, 26 Jul 2015 14:20:53 +0000 Cryptosporidiosis is a worldwide zoonosis caused by Cryptosporidium spp., sometimes leading to severe diarrhea in humans and animals. In the present study, 311 parrots, belonging to four species, namely, Budgerigars (Melopsittacus undulatus), Lovebirds (Agapornis sp.), Alexandrine parakeets (Psittacula eupatria), and Cockatiel (Nymphicus hollandicus), from Beijing and Weifang cities, were examined for Cryptosporidium spp. infection. Blood samples of each bird were examined using enzyme linked immunosorbent assay (ELISA) and fecal samples were examined by Sheather’s sugar flotation technique. Prevalence of Cryptosporidium infection were 3.22% (10/311) and 0.64% (2/311) by ELISA and Sheather’s sugar flotation technique, respectively. Seroprevalence of Cryptosporidium infection in different breeds varied from 0 to 15.39%. Sequencing analysis showed that both positive samples from fecal samples belonged to Cryptosporidium avian genotype V. This is the first report of Cryptosporidium avian genotype V in Budgerigars. The results of the present study provided foundation-data for prevention and control of cryptosporidiosis in pet birds in China. Xiao-Xuan Zhang, Nian-Zhang Zhang, Guang-Hui Zhao, Quan Zhao, and Xing-Quan Zhu Copyright © 2015 Xiao-Xuan Zhang et al. All rights reserved. Using Sibling Designs to Understand Neurodevelopmental Disorders: From Genes and Environments to Prevention Programming Wed, 15 Jul 2015 10:05:37 +0000 Neurodevelopmental disorders represent a broad class of childhood neurological conditions that have a significant bearing on the wellbeing of children, families, and communities. In this review, we draw on evidence from two common and widely studied neurodevelopmental disorders—autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD)—to demonstrate the utility of genetically informed sibling designs in uncovering the nature and pathogenesis of these conditions. Specifically, we examine how twin, recurrence risk, and infant prospective tracking studies have contributed to our understanding of genetic and environmental liabilities towards neurodevelopmental morbidity through their impact on neurocognitive processes and structural/functional neuroanatomy. It is suggested that the siblings of children with ASD and ADHD are at risk not only of clinically elevated problems in these areas, but also of subthreshold symptoms and/or subtle impairments in various neurocognitive skills and other domains of psychosocial health. Finally, we close with a discussion on the practical relevance of sibling designs and how these might be used in the service of early screening, prevention, and intervention efforts that aim to alleviate the negative downstream consequences associated with disorders of neurodevelopment. Mark Wade, Heather Prime, and Sheri Madigan Copyright © 2015 Mark Wade et al. All rights reserved. Effects of Surface Inclination on the Vertical Loading Rates and Landing Pattern during the First Attempt of Barefoot Running in Habitual Shod Runners Wed, 15 Jul 2015 06:51:49 +0000 Barefoot running has been proposed to reduce vertical loading rates, which is a risk factor of running injuries. Most of the previous studies evaluated runners on level surfaces. This study examined the effect of surface inclination on vertical loading rates and landing pattern during the first attempt of barefoot running among habitual shod runners. Twenty habitual shod runners were asked to run on treadmill at 8.0 km/h at three inclination angles (0°; +10°; −10°) with and without their usual running shoes. Vertical average rate (VALR) and instantaneous loading rate (VILR) were obtained by established methods. Landing pattern was decided using high-speed camera. VALR and VILR in shod condition were significantly higher () in declined than in level or inclined treadmill running, but not in barefoot condition (). There was no difference () in the landing pattern among all surface inclinations. Only one runner demonstrated complete transition to non-heel strike landing in all slope conditions. Reducing heel strike ratio in barefoot running did not ensure a decrease in loading rates (). Conversely, non-heel strike landing, regardless of footwear condition, would result in a softer landing (). W. An, M. J. Rainbow, and R. T. H. Cheung Copyright © 2015 W. An et al. All rights reserved. Musculoskeletal Injuries and Training Patterns in Junior Elite Orienteering Athletes Wed, 15 Jul 2015 06:11:34 +0000 Findings about the relation between musculoskeletal injuries and training patterns in orienteering athletes are sparse. Therefore, the musculoskeletal injuries and training patterns of 31 Swiss elite orienteering athletes aged 18-19 years were analyzed in a retrospective study. Individual training diaries and medical records were used to assess training data and injury history, respectively. Group comparisons and a multiple linear regression (MLR) were performed for statistical analysis. The junior elite orienteering athletes performed 7.38 ± 2.00 training sessions weekly, with a total duration of 455.75 ± 98.22 minutes. An injury incidence rate (IIR) of 2.18 ± 2.13 injuries per 1000 hours of training was observed. The lower extremity was affected in 93% of all injuries, and the knee (33%) was the most commonly injured location. The MLR revealed that gender and six training variables explained 60% of the variance in the injury severity index in this study. Supported by the low IIR in the observed age group, the training protocol of the junior elite orienteering athletes was generally adequate. In comparison to elite track, marathon, and orienteering athletes, the junior elite athletes performed less high-intensity interval training (HIIT). However, more frequent HIIT seems to be a protective factor against injuries. Lilian Roos, Wolfgang Taube, Peter Zuest, German Clénin, and Thomas Wyss Copyright © 2015 Lilian Roos et al. All rights reserved. Effectiveness of the First Dose of BCG against Tuberculosis among HIV-Infected, Predominantly Immunodeficient Children Mon, 29 Jun 2015 09:25:03 +0000 The objective of this study was to estimate the protective effect of Bacille Calmette-Guérin (BCG) vaccine against tuberculosis among (predominantly immunodeficient) HIV-infected children in Angola. A hospital-based case-control study was conducted with 230 cases, children coinfected with tuberculosis, and 672 controls, HIV-infected children from the same hospital, aged 18 months to 13 years. The presence of a vaccination scar was taken as a proxy marker for BCG vaccination. The crude effectiveness was 8% (95% CI: −26 to 32) and the adjusted effectiveness was 30% (95% CI: −75 to 72). The present study suggests that BCG does not have a protective effect against tuberculosis among immunodeficient HIV-infected children. Since BCG is no longer given to HIV-infected children, the study may not be replicated. Accepting that these findings should be considered with caution, they are nonetheless likely to be the last estimate of BCG efficacy in a sufficiently powered study. Joaquim C. V. D. Van-Dunem, Laura C. Rodrigues, Luiz Claudio Arraes Alencar, Maria de Fátima Pessoa Militão-Albuquerque, and Ricardo Arraes de Alencar Ximenes Copyright © 2015 Joaquim C. V. D. Van-Dunem et al. All rights reserved. Epidemiology of Neonatal Sepsis and Implicated Pathogens: A Study from Egypt Thu, 04 Jun 2015 12:54:04 +0000 Prospective analytic study was conducted in NICUs of three Egyptian Neonatal Network (EGNN) participants in Mansoura Hospitals in Egypt over a period of 18 months from March 2011 to August 2012. By using EGNN 28-day discharge form, all demographic, clinical, and laboratory data were recorded and studied. During the study period, 357 neonates were diagnosed as suspected sepsis with an incidence of 45.9% (357/778) among the admitted neonates at the three neonatal intensive care units. 344 neonates (sex ratio = 1.3:1) were enrolled in the study in which 152 (44.2%) were classified as early onset sepsis EOS (≤72 hr) and 192 (55.8%) as late onset sepsis LOS (>72 hr). Among the LOS cases, 33.9% (65/192) were caused by nosocomial infections. In 40.7% (140/344), sepsis was confirmed by positive blood culture. The total mortality rate for the proven neonatal sepsis was 51% (25/49) and 42.9% (39/91) for EOS and LOS, respectively. Coagulase negative staphylococci were predominant isolates in both EOS and LOS, followed by Klebsiella pneumoniae. Most of the bacterial isolates had low sensitivity to the commonly used empiric antibiotics. However, 70.1% (89/127) exhibited multidrug resistance. Best sensitivities among Gram-positive isolates were found against imipenem, ciprofloxacin, vancomycin, and amikacin. Eman M. Rabie Shehab El-Din, Mohamed M. Adel El-Sokkary, Mohamed Reda Bassiouny, and Ramadan Hassan Copyright © 2015 Eman M. Rabie Shehab El-Din et al. All rights reserved. Evaluation of an Indirect-ELISA Test for Trypanosoma evansi Infection (Surra) in Buffaloes and Its Application to a Serological Survey in Thailand Mon, 25 May 2015 13:39:34 +0000 Surra, caused by Trypanosoma evansi, is a neglected disease due to frequent subclinical evolution, especially in bovines in Asia. However, acute and chronic signs are regularly observed, with significant sanitary and economic impacts. In this study, we evaluated and applied an indirect-ELISA test for the detection of anti-T. evansi immunoglobulin G in buffaloes using antibovine conjugate. Based on buffalo reference sera from the Philippines, a two-graph receiver operating characteristics analysis (TG-ROC) was conducted to define an optimal cut-off value; sensitivity and specificity were estimated at 92.5% and 94.2%, respectively. A cross-sectional serological survey was carried out in the major buffalo breeding areas of Thailand; 892 buffaloes from 8 provinces were sampled in North, Northeastern, and Southern Thailand. Seropositive buffaloes were found in all 8 provinces, on 20.3% of farms for an overall prevalence of 12.2% (95% CI 10.2–14.5%). Nearly one-third of the sampled population was exposed to infection. Broader sampling would be necessary but is not possible in the southern half-wild breeding systems. According to our results, buffaloes may constitute a large and robust reservoir for T. evansi, which is a permanent threat to other livestock such as cattle and horses as well as wild animals such as elephants in Southest Asia. Arthur Kocher, Marc Desquesnes, Ketsarin Kamyingkird, Sarawut Yangtara, Emilye Leboucher, Pranee Rodtian, Alan Dargantes, and Sathaporn Jittapalapong Copyright © 2015 Arthur Kocher et al. All rights reserved. Acute Leukemia in Children Wed, 20 May 2015 06:57:52 +0000 Juan Manuel Mejía-Aranguré and Richard J. Q. McNally Copyright © 2015 Juan Manuel Mejía-Aranguré and Richard J. Q. McNally. All rights reserved. Maternal Alcohol Consumption during Pregnancy and Early Age Leukemia Risk in Brazil Mon, 18 May 2015 14:20:47 +0000 Objectives. To investigate the association between the maternal alcohol consumption during pregnancy and early age leukemia (EAL) in offspring. Methods. Datasets were analyzed from a case-control study carried out in Brazil during 1999–2007. Data were obtained by maternal interviews using a standardized questionnaire. The present study included 675 children (193 acute lymphoid leukemia (ALL), 59 acute myeloid leukemia (AML), and 423 controls). Unconditional logistic regression was performed, and adjusted odds ratios (adj. OR) on the association between alcohol consumption and EAL were ascertained. Results. Alcohol consumption was reported by 43% of ALL and 39% of AML case mothers and 35.5% of controls’. Beer consumption before and during pregnancy was associated with ALL in crude analysis (OR = 1.54, 95% CI, 1.08–2.19), although in adjusted analysis no statistical significance was found. For weekly intake of ≤1 glass (adj. OR = 1.30, 95% CI, 0.71–2.36) and ≥1 glass/week (adj. OR = 1.47, 95% CI, 0.88–2.46) a potential dose-response was observed ( trend < 0.03). Conclusion. This study failed to support the hypothesis of an increased risk of EAL associated with maternal alcohol intake during pregnancy, neither with the interaction with tobacco nor with alcohol consumption. Jeniffer Dantas Ferreira, Arnaldo Cézar Couto, Mariana Emerenciano, Maria S. Pombo-de-Oliveira, and Sergio Koifman Copyright © 2015 Jeniffer Dantas Ferreira et al. All rights reserved. Role of Genetic Polymorphisms of Deoxycytidine Kinase and Cytidine Deaminase to Predict Risk of Death in Children with Acute Myeloid Leukemia Mon, 18 May 2015 12:13:27 +0000 Cytarabine is one of the most effective antineoplastic agents among those used for the treatment of acute myeloid leukemia. However, some patients develop resistance and/or severe side effects to the drug, which may interfere with the efficacy of the treatment. The polymorphisms of some Ara-C metabolizing enzymes seem to affect outcome and toxicity in AML patients receiving cytarabine. We conducted this study in a cohort of Mexican pediatric patients with AML to investigate whether the polymorphisms of the deoxycytidine kinase and cytidine deaminase enzymes are implicated in clinical response and toxicity. Bone marrow and/or peripheral blood samples obtained at diagnosis from 27 previously untreated pediatric patients with de novo AML were processed for genotyping and in vitro chemosensitivity assay, and we analyzed the impact of genotypes and in vitro sensitivity on disease outcome and toxicity. In the multivariate Cox regression analysis, we found that age at diagnosis, wild-type genotype of the CDA A79C polymorphism, and wild-type genotype of the dCK C360G polymorphism were the most significant prognostic factors for predicting the risk of death. Aurora Medina-Sanson, Arturo Ramírez-Pacheco, Silvia Selene Moreno-Guerrero, Elisa María Dorantes-Acosta, Metzeri Sánchez-Preza, and Alfonso Reyes-López Copyright © 2015 Aurora Medina-Sanson et al. All rights reserved. Bone Marrow Cells in Acute Lymphoblastic Leukemia Create a Proinflammatory Microenvironment Influencing Normal Hematopoietic Differentiation Fates Mon, 18 May 2015 09:51:50 +0000 B-cell acute lymphoblastic leukemia (B-ALL) is a serious public health problem in the pediatric population worldwide, contributing to 85% of deaths from childhood cancers. Understanding the biology of the disease is crucial for its clinical management and the development of therapeutic strategies. In line with that observed in other malignancies, chronic inflammation may contribute to a tumor microenvironment resulting in the damage of normal processes, concomitant to development and maintenance of neoplastic cells. We report here that hematopoietic cells from bone marrow B-ALL have the ability to produce proinflammatory and growth factors, including TNFα, IL-1β, IL-12, and GM-CSF that stimulate proliferation and differentiation of normal stem and progenitor cells. Our findings suggest an apparently distinct CD13+CD33+ population of leukemic cells contributing to a proinflammatory microenvironment that may be detrimental to long-term normal hematopoiesis within B-ALL bone marrow. Armando Vilchis-Ordoñez, Adriana Contreras-Quiroz, Eduardo Vadillo, Elisa Dorantes-Acosta, Alfonso Reyes-López, Henry Martin Quintela-Nuñez del Prado, Jorge Venegas-Vázquez, Hector Mayani, Vianney Ortiz-Navarrete, Briceida López-Martínez, and Rosana Pelayo Copyright © 2015 Armando Vilchis-Ordoñez et al. All rights reserved. Disparities in Prevalence of Smoking and Smoking Cessation during Pregnancy: A Population-Based Study Thu, 14 May 2015 13:36:20 +0000 Objective. To examine time trends in prevalence of smoking and smoking cessation during pregnancy by family income, maternal level of education, skin color, and age. Methods. We conducted three population-based surveys in 2007, 2010, and 2013 with newly delivered mothers living in the municipality of Rio Grande, Southern Brazil. Data were collected using questionnaires administered after delivery in all (two) maternity units in the city, at Dr. Miguel Riet Corrêa Júnior Hospital and at Santa Casa de Misericórdia. Time trends were analyzed using chi-square test for linear trend. Results. Data of 7,572 women showed that the prevalence of smoking before pregnancy decreased from 28% (26.2–29.7) in 2007 to 22% (20.8–24.0) in 2013 (). Prevalence of smoking during pregnancy decreased from 22% (20.4–23.7) in 2007 to 18% (16.6–19.5) in 2013 (). This reduction varied across income ranging from 17% (poorest) to 35% (richest) (). The lower the income, the higher the smoking prevalence during pregnancy. Smoking cessation was more prevalent among women of higher level of education and income. Conclusions. Smoking before and during pregnancy is still highly prevalent and the prevalence of cessation is low pointing to a need to strengthen actions targeting low-income, less educated, black pregnant women. Josiane L. Dias-Damé and Juraci A. Cesar Copyright © 2015 Josiane L. Dias-Damé and Juraci A. Cesar. All rights reserved. Candida Bloodstream Infections in Italy: Changing Epidemiology during 16 Years of Surveillance Thu, 07 May 2015 13:39:49 +0000 Although considerable progress has been made in the management of patients with invasive fungal infections, Candida bloodstream infections are still widespread in hospital settings. Incidence rates vary geographically, often because of different patient populations. The aim of the present study was to describe the epidemiology of candidemia, to analyze the trend of species distribution, and to measure the in vitro susceptibility to antifungal drugs in a university Italian hospital from 1998 to 2013. The antifungal susceptibility for all Candida isolates was evaluated by broth microdilution assay (CLSI M27-A3 document). Of 394 episodes of candidemia, the average incidence was 3.06/10 000 admissions. C. albicans and non-albicans Candida species caused 44.2% and 55.8% of the episodes, respectively. C. parapsilosis (62.2%) was the most common non-albicans.  C. albicans predominated in almost all departments whereas C. parapsilosis was found in adult and paediatric oncohaematology units (34.8% and 77.6%, resp.). Overall, mortality occurred in 111 (28.2%) patients. Death occurred most often in intensive care units (47.1%) and specialist surgeries (43.7%). Most of the isolates were susceptible to antifungal drugs, but there was an upward trend for azole (). In conclusion, this study emphasizes the importance of monitoring local epidemiologic data and the diversity of patient groups affected. Giuseppina Caggiano, Caterina Coretti, Nicola Bartolomeo, Grazia Lovero, Osvalda De Giglio, and Maria Teresa Montagna Copyright © 2015 Giuseppina Caggiano et al. All rights reserved. Substance Use and Dual Diagnosis Disorders: Future Epidemiology, Determinants, and Policies Tue, 05 May 2015 08:46:27 +0000 Sahoo Saddichha, Christian G. Schütz, Baxi Neeraj Prasad Sinha, and Narayana Manjunatha Copyright © 2015 Sahoo Saddichha et al. All rights reserved. Khat Use: What Is the Problem and What Can Be Done? Sun, 03 May 2015 14:20:50 +0000 The chewing of khat leaves is an established tradition in East Africa but is much less prevalent in other areas of the world and is mostly limited to Somali communities. However, our understanding of what constitutes problematic khat use in the Somali community in Victoria, Australia, is limited. The objectives of this study were to better understand the views of Somali community representatives and primary care practitioners regarding problematic khat use, to consider relevant harm minimisation strategies, and to develop resources to assist individuals with problematic khat use and their families. Qualitative research methods were used to investigate the experiences and perceptions of khat use among Somalis and mainstream primary care practitioners. Six focus groups were conducted with 37 members of the Somali community and 11 primary care practitioners. Thematic analysis was used to analyse transcripts. Various indicators of the problematic use of khat were identified, including adverse physical and mental health effects, social isolation, family breakdown, and neglect of social responsibilities. Potential harm minimisation strategies were identified including the adoption of health promotion through education, outreach to the community, and the use of universal harm minimisation strategies specifically tailored to khat use. Yusuf Sheikh Omar, Anna Jenkins, Marieke van Regteren Altena, Harvey Tuck, Chris Hynan, Ahmed Tohow, Prem Chopra, and David Castle Copyright © 2015 Yusuf Sheikh Omar et al. All rights reserved. Attention Deficit Hyperactivity Disorder Symptoms, Comorbidities, Substance Use, and Social Outcomes among Men and Women in a Canadian Sample Sun, 03 May 2015 12:17:49 +0000 Background. Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that can persist in adolescence and adulthood. Aim. To examine prevalence of ADHD symptoms and correlates in a representative sample of adults 18 years and older living in Ontario, Canada. Method. We used the Centre for Addiction and Mental Health Monitor, an ongoing cross-sectional telephone survey, to examine the relationships between ADHD positive symptoms and comorbidities, substance use, medication use, social outcomes, and sociodemographics. Results. Of 4014 residents sampled in 2011-2012, 3.30% (2.75%–3.85%) screened positively for ADHD symptoms (women = 3.6%; men = 3.0%). For men, distress, antisocial symptoms, cocaine use, antianxiety medication use, antidepressant medication use, and criminal offence arrest were associated with positive ADHD screen. For women, distress, cocaine use, antianxiety medication use, antidepressant medication use, pain medication use, and motor vehicle collision in the past year were associated with positive ADHD screen. Conclusions. ADHD symptoms are associated with adverse medical and social outcomes that are in some cases gender specific. Evelyn Vingilis, Patricia G. Erickson, Maggie E. Toplak, Nathan J. Kolla, Robert E. Mann, Jane Seeley, Mark vanderMaas, and Deanne S. Daigle Copyright © 2015 Evelyn Vingilis et al. All rights reserved. Reflections on Addiction in Students Using Stimulants for Neuroenhancement: A Preliminary Interview Study Sun, 03 May 2015 08:57:17 +0000 The use of stimulants for the purpose of pharmacological neuroenhancement (NE) among students is a subject of increasing public awareness. The risk of addiction development by stimulant use for NE is still unanswered. Therefore, face-to-face interviews were carried out among 18 university students experienced in the nonmedical use of methylphenidate and amphetamines for NE assessing aspects of addiction. Interviews were tape-recorded, verbatim-transcribed, and analyzed using a qualitative approach. The interviews showed that participants—the majority had current or lifetime diagnoses of misuse or addiction to alcohol or cannabis—reported an awareness of the risk of addiction development associated with stimulant use and reported various effects which may increase their likelihood of future stimulant use, for example, euphoric effects, increase of self-confidence, and motivation. They also cited measures to counteract the development of addiction as well as measures taken to normalize again after stimulant use. Students were convinced of having control over their stimulant use and of not becoming addicted to stimulants used for NE. We can conclude that behavior and beliefs of the students in our sample appear to be risky in terms of addiction development. However, long-term empirical research is needed to estimate the true risk of addiction. Elisabeth Hildt, Klaus Lieb, Christiana Bagusat, and Andreas G. Franke Copyright © 2015 Elisabeth Hildt et al. All rights reserved. The Effect of Nicotine Dependence on Psychopathology in Patients with Schizophrenia Tue, 28 Apr 2015 07:17:02 +0000 Introduction. Our study aims to determine the prevalence of nicotine dependence and investigate the effect of nicotine dependence on psychopathology among schizophrenia patients. Methods. A cross-sectional study was carried out in an outpatient psychiatric clinic at a general hospital in Malaysia. 180 recruited subjects were administered the Malay version of Mini International Neuropsychiatric Interview (MINI), the Positive and Negative Symptom Scale (PANSS), and the Malay version of Fagerstrom Test for Nicotine Dependence (FTND-M) questionnaires. Results. The prevalence of nicotine dependence among the subjects was 38.1% () and they were mainly composed of male gender, Malay ethnicity, being treated with atypical antipsychotics, and taking other illicit drugs or alcohol. Subjects with severe nicotine dependence scored less in the negative subscale of PANSS compared with the nonsmokers (). On performing the hierarchy multiple regressions, dependence status still significantly predicted negative scores after adjusting the confounders (, ). Conclusion. The rate of nicotine use disorder among schizophrenia patients in this study is higher than that of the general population in Malaysia. The significant association between nicotine dependence and negative psychopathology symptoms will help the healthcare practitioners in their management of nicotine dependence among schizophrenia patients. Anne Yee, Nik Nasyrah Bt Nek Mohamed, Aili Hanim Binti Hashim, Huai Seng Loh, Manveen Kaur Harbajan Singh, Chong Guan Ng, and S. T. Jambunathan Copyright © 2015 Anne Yee et al. All rights reserved. Revictimization of Violence Suffered by Those Diagnosed with Alcohol Dependence in the General Population Mon, 27 Apr 2015 10:01:06 +0000 Objective. To verify the association between violence and alcohol dependence syndrome in sample populations. Method. Population-wide survey with multistage probabilistic sample. 3,744 individuals of both genders, aged from 15 to 75 years, were interviewed from the cities of São Paulo and Rio de Janeiro using the Composite International Diagnostic Interview (CIDI 2.1). Results. In both cities, alcohol dependence was associated with the male gender, having suffered violence related to criminality, and having suffered familial violence. In both cities, urban violence, in more than 50% of cases, and familial violence, in more than 90% of cases, preceded alcohol dependence. The reoccurrence of traumatic events occurred in more than half of individuals dependent on alcohol. In São Paulo, having been diagnosed with PTSD is associated with violence revictimization (; ). Conclusion. Alcohol dependence syndrome is complexly related to urban and familial violence in the general population. Violence frequently precedes alcoholism, but this relationship is dependent on residence and traumatic events. This vicious cycle contributes to perpetuating the high rates of alcoholism and violence in the cities. Politicians ordering the reduction of violence in the large metropolises can, potentially, reduce alcoholism and contribute to the break of this cycle. F. G. Moreira, M. I. Quintana, W. Ribeiro, R. A. Bressan, M. F. Mello, J. J. Mari, and S. B. Andreoli Copyright © 2015 F. G. Moreira et al. All rights reserved. Seroprevalence of Toxoplasma gondii Infection in Patients of Intensive Care Unit in China: A Hospital Based Study Thu, 16 Apr 2015 12:28:50 +0000 The objective of this study was to estimate the seroprevalence of Toxoplasma gondii infection in 394 patients of intensive care unit (ICU) in a hospital between April 2010 and March 2012 and analyze the association between T. gondii infection and ICU patients according to the species of disease. Toxoplasma serology was evaluated by ELISA method using a commercially available kit. Data of patients were obtained from the patients, informants, and medical examination records. Seventy-four (18.78%) of 394 patients were positive for anti-T. gondii IgG antibodies demonstrating latent infection. Of these, the highest T. gondii seroprevalence was found in the age group of 31–45 years (27.45%), and the lowest was found in the age group of <30 years (12.5%). In addition, females (21.6%) had a higher seroprevalence than males (18.36%). With respect to the species of disease, the patients with kidney diseases (57.14%), lung diseases (27.84%), and brain diseases (24%) had high T. gondii seroprevalence. The present study represents the first survey of T. gondii seroprevalence in ICU patients in China, revealing an 18.78% seropositivity. Considering the particularities of ICU patients, molecular identification, genetic characterization, and diagnosis of T. gondii should be considered in future study. Yong-Biao Zhang, Wei Cong, Zhi-Tao Li, Xiao-Gang Bi, Ying Xian, Yan-Hong Wang, Xing-Quan Zhu, and Kou-Xing Zhang Copyright © 2015 Yong-Biao Zhang et al. All rights reserved. First Report of Hepatitis E Virus Infection in Sika Deer in China Thu, 09 Apr 2015 09:55:06 +0000 Hepatitis E virus (HEV), a single stranded RNA, nonenveloped virus, belongs to the genus Hepevirus, in the family of Hepeviridae. In this study, 46 (5.43%) out of the 847 serum samples from sika deer (Cervus nippon) were detected as seropositive with hepatitis E virus (HEV) by enzyme linked immunosorbent assay (ELISA). These samples were collected from Inner Mongolia and Jilin and Heilongjiang provinces in China, between October 2012 and October 2013. Seroprevalence of HEV infection in male and female deer was 4.82% and 6.52%, respectively. HEV seroprevalence in sika deer from different geographical locations varied from 3.13% to 6.73%. There was no significant difference in HEV seroprevalence between sika deer collected in autumn (5.65%) and winter (4.85%). This is the first report of HEV seroprevalence in sika deer in China, which will provide foundation information for estimating the effectiveness of future measures to control HEV infection in sika deer in China and assessing the potential risk of humans infected with HEV after consumption of undercooked or raw meat from infected sika deer. Xiao-Xuan Zhang, Si-Yuan Qin, Yuan Zhang, Qing-Feng Meng, Jing Jiang, Gui-Lian Yang, Quan Zhao, and Xing-Quan Zhu Copyright © 2015 Xiao-Xuan Zhang et al. All rights reserved. Variants of SCARB1 and VDR Involved in Complex Genetic Interactions May Be Implicated in the Genetic Susceptibility to Clear Cell Renal Cell Carcinoma Mon, 06 Apr 2015 09:57:55 +0000 The current data are still inconclusive in terms of a genetic component involved in the susceptibility to renal cell carcinoma. Our aim was to evaluate 40 selected candidate polymorphisms for potential association with clear cell renal cell carcinoma (ccRCC) based on independent group of 167 patients and 200 healthy controls. The obtained data were searched for independent effects of particular polymorphisms as well as haplotypes and genetic interactions. Association testing implied position rs4765623 in the SCARB1 gene (, 95% CI: 1.104–2.582, ) and a haplotype in VDR comprising positions rs739837, rs731236, rs7975232, and rs1544410 () to be the risk factors in the studied population. The study detected several epistatic effects contributing to the genetic susceptibility to ccRCC. Variation in GNAS1 was implicated in a strong synergistic interaction with BIRC5. This effect was part of a model suggested by multifactor dimensionality reduction method including also a synergy between GNAS1 and SCARB1 (). Significance of GNAS1-SCARB1 interaction was further confirmed by logistic regression (), which also indicated involvement of SCARB1 in additional interaction with EPAS1 () as well as revealing interactions between GNAS1 and EPAS1 (), GNAS1 and MC1R (), GNAS1 and VDR (), and MC1R and VDR (). Ewelina Pośpiech, Janusz Ligęza, Wacław Wilk, Aniela Gołas, Janusz Jaszczyński, Andrzej Stelmach, Janusz Ryś, Aleksandra Blecharczyk, Anna Wojas-Pelc, Jolanta Jura, and Wojciech Branicki Copyright © 2015 Ewelina Pośpiech et al. All rights reserved. Seroprevalence and Risk Factors of Chlamydia Infection in Domestic Rabbits (Oryctolagus cuniculus) in China Sun, 05 Apr 2015 09:25:04 +0000 Chlamydia spp. are obligate intracellular bacteria distributed all over the world, known to cause various forms of diseases in animals and humans. In the present study, a serological survey was conducted to detect the seroprevalence and risk factors associated with rabbit chlamydiosis in northeast China, including Liaoning province, Jilin province, Heilongjiang province, and Inner Mongolia Autonomous Region. Antibodies to Chlamydia were determined by indirect hemagglutination assay (IHA). The overall seroprevalence was estimated at 17.88% in total of 800 blood samples. The Chlamydia seroprevalence varied in domestic rabbits from different factors, and genders of domestic rabbits were considered as major risk factors associated with Chlamydia infection. Our study revealed a widespread and high prevalence of Chlamydia infection in domestic rabbits in northeast China, with higher exposure risk in female domestic rabbits. These findings suggested the potential importance of domestic rabbits in the transmission of zoonotic Chlamydia infection, and thus Chlamydia should be taken into consideration in diagnosing rabbit diseases. To our knowledge, there is no report of Chlamydia infection in domestic rabbits in China and the results extend the host range for Chlamydia, which has important implications for public health and the local economy. Xiaoting Ni, Siyuan Qin, Zhilong Lou, Hongrui Ning, and Xiaolin Sun Copyright © 2015 Xiaoting Ni et al. 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.