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prophylaxis - Top 30 Publications

Bacteriuria and Symptomatic Urinary Tract Infections during Antimicrobial Prophylaxis in Patients with Short-Term Urinary Catheters - Prospective Randomised Study in Patients after Joint Replacement Surgery.

PURPOSE OF THE STUDY A very serious complication following joint replacement surgery is periprosthetic joint infection that can be caused by a urinary tract infection. Insertion of an indwelling urinary catheter constitutes a risk factor that may result in urinary tract infections. The aim of this prospective randomised study was to compare the occurrence of significant bacteriuria and symptomatic urinary tract infections during antibiotic prophylaxis at the time of removal of an indwelling urinary catheter by cotrimoxazole in two doses and with no administration of antibiotics. We also monitored the incidence of potential periprosthetic infection following the endoprosthesis implantation. The findings of preoperative urine tests were compared with the declared negative preoperative examination. MATERIAL AND METHODS The study included patients indicated for a total hip or knee replacement with a negative urine culture as a part of the preoperative testing. Where leukocyteria was detected, urine culture by mid-stream clean catch urine was obtained. The second part included patients, in whom an indwelling urinary catheter had to be inserted postoperatively for urine retention and/or monitoring of fluid balance and who were divided into two groups on a rota basis. No antibiotics were administered to the first group, whereas Cotrimoxazol 960 mg tablets p.o. was administered to the second group, 14 and 2 hours before the removal of the catheter. The urine culture test was performed 4 hours after the removal of the indwelling urinary catheter, in both the groups. The test was repeated after 14 days and a questionnaire was filled in to report urinary tract complications. Considered as significant bacteriuria by urinalysis was the laboratory finding of > 10x4 CFU/ml in case of a single pathogen or > 10x5 in case of multiple pathogens. The results were statistically processed by Fischer's exact test with the level of significance = 0.05. RESULTS In the first part of the study leukocyturia was detected by a test strip in 112 of the total of 478 patients. In 10 women, significant bacteriuria was found. Altogether 50 women and 50 men were randomly assigned to the second part of the study. The indwelling urinary catheter was in place for 4 days on average. In men, no statistically significant difference was detected in significant bacteriuria findings, in women a statistically significant difference of p = 0.00162 was found after the removal and after 14 days the borderline of statistical significance of p = 0.0507 was achieved, but no symptomatic urinary tract infection was present. In the period from 20 to 32 months following the total joint replacement, no periprosthetic infection caused by urinary tract infection was reported. DISCUSSION There is enough evidence to prove the correlation between the symptomatic urinary tract infection and periprosthetic infection. On the other hand, asymptomatic bacteriuria is a common finding in patients before the planned hip of knee joint replacement and its treatment is not recommended. No consensus has been achieved as yet regarding the method of antibiotic prophylaxis for an inserted urinary catheter. Antibiotics are administered throughout the period of catheterisation by an indwelling urinary catheter, during its removal, or are not administered at all. In our study antibiotics were administered during the removal of an indwelling urinary catheter and a statistically significant difference was found in women. It concerned, however, only a higher incidence of asymptomatic bacteriuria not treated by antibiotics, which in the next follow-up period did not lead to periprosthetic infection. CONCLUSIONS Despite the negative pre-operative urine culture, frequent incidence of leukocyturia and symptomatic urinary infections were detected in a fairly high number of cases. Therefore, we recommend asking the patients during the hospital admission process specifically about the urinary infection symptoms. The results of our study show that antibiotic prophylaxis during the removal of indwelling urinary catheters placed for a short-term is unnecessary. Key words: endoprosthesis, urinary catheter, bacteriuria, urinary tract infection.

Results of Surgically Treated Patients for Hip Fracture - Complications, Mortality.

PURPOSE OF THE STUDY Our main objective was to evaluate the mortality and complications of patients following surgical treatment of hip fractures and to identify the associated risk factors for postoperative mortality. MATERIAL AND METHODS We retrospectively reviewed all patients over the age of 50 who underwent surgical treatment for femoral neck and peritrochanteric fractures at our institution in 2003 and 2013. Mortality was compared between subgroups classified by age, gender, fracture type, method of treatment. Correlation between mortality and postoperative complications, time to surgery, and blood transfusion need were evaluated. Chi-square was used for categorical variables and two-tailed student's t-test for continuous variables. Survival curves were compared by the log-rank test. Mortality rates were adjusted for patient age and compared to the mortality rates of Prague's population in the given years. RESULTS Altogether 425 patients were surgically treated for proximal femoral fracture in 2013, while 229 patients were treated in 2003. The overall 1-year mortality decreased by 10% over the study period (38% in 2003 and 28% in 2013), despite the higher average age in 2013. Survival was better in all subgroups broken down by diagnosis and method of treatment, statistically relevant in the subgroup of femoral neck fractures, notwithstanding the method of treatment and in the subgroup treated with total hip arthroplasty. The strongest prognostic factor for survival was the advanced age. The mortality rate rises significantly over the age of 75. The largest age group was between 85-89 years, with 1-year mortality rate of 32%. The annual mortality of the general population in Prague aged 85-89 years was 13% and has improved only by 1% in the decade. The reoperative rate was 4% and did not affect mortality. There was no significant relationship between mortality and complications or delay of surgery for up to 4 days. DISCUSSION The factors that might have contributed to better survival are the introduction of guidelines for hip fracture care to our unit, better prophylaxis of venous thromboembolism, improvement of surgical skills due to the growing volume of these cases, and a higher rate of discharges to aftercare units. CONCLUSIONS Mortality has significantly decreased between 2003 and 2013 (p < 0.001). We didn't find a correlation between mortality and delay of surgery up to 4 days. That means that a complicated operation such as hip arthroplasty could be postponed and operated in more comfortable conditions (in superaseptic OR) by orthopedic surgeons. Although we haven't identified any modifiable risk factor, we believe that the reasons for better survival are multifactorial as discussed. Key words: hip fracture, proximal femoral fracture, mortality, complications, time to surgery.

Development of a recombinase polymerase amplification assay for Vibrio parahaemolyticus detection with an internal amplification control.

A novel RPA-IAC assay using recombinase polymerase and an internal amplification control (IAC) for Vibrio parahaemolyticus detection was developed. Specific primers were designed based on the coding sequence (CDS) for the toxR gene in V. parahaemolyticus. The recombinase polymerase amplification (RPA) reaction was conducted at a constant low temperature of 37°C for 20 min. Assay specificity was validated by using 63 Vibrio strains and 10 non-Vibrio bacterial species. In addition, a competitive IAC was employed to avoid false-negative results, which co-amplified simultaneously with the target sequence. The sensitivity of the assay was determined as 3×103 CFU/mL, which is decidedly more sensitive than the established PCR method. This method was then used to test seafood samples which were collected from local market. 7 out of 53 different raw seafoods were detected as V.p positive, which were consistent with those obtained using traditional culturing method and biochemical assay. This novel RPA-IAC assay provides a rapid, specific, sensitive and more convenient detection method for V. parahaemolyticus.

Invasive bacterial disease trends and characterization of group B streptococcal isolates among young infants in southern Mozambique, 2001-2015.

Maternal group B streptococcal (GBS) vaccines under development hold promise to prevent GBS disease in young infants. Sub-Saharan Africa has the highest estimated disease burden, although data on incidence and circulating strains are limited. We described invasive bacterial disease (IBD) trends among infants <90 days in rural Mozambique during 2001-2015, with a focus on GBS epidemiology and strain characteristics.

A Pilot Randomized Controlled Trial of a Phone-based Intervention for Smoking Cessation and Relapse Prevention in the Postpartum Period.

To pilot-test a Phone-based Postpartum Continuing Care (PPCC) protocol developed from existing evidence-based approaches to address both postpartum smoking relapse among low-income women who quit smoking during pregnancy and postpartum smoking increase among those who had cut down.

Early Response to Warfarin Initiation and the Risk of Venous Thromboembolism After Total Joint Arthroplasty.

Venous thromboembolism chemoprophylaxis with warfarin is common after total joint arthroplasty. Early response to warfarin initiation has been theorized to engender a transient increase in the risk of venous thromboembolism. We hypothesized that a rapid rise in the international normalized ratio is a risk factor for venous thromboembolism after total joint arthroplasty.

Four Months of Wearing a Balance Orthotic Improves Measures of Balance and Mobility Among a Cohort of Community-Living Older Adults.

The Centers for Disease Control and Prevention estimated that there were 29 million falls and 7 million injuries in 2014 in the United States. Falls, decreased balance, and mobility disability are common in older adults and often result in loss of independence. Finding interventions to address these issues is important, as this age group is growing exponentially. Prior studies indicate balance and mobility can be improved by the balance-based torso-weighting (BBTW) assessment implemented through wear of a balance orthotic (BO). This study sought to determine the impact of wearing a BO on balance, mobility, and fall risk over time.

An integrated operational definition and conceptual model of asthma self-management in teens.

A previous definition of adolescent asthma self-management was derived from interviews with clinicians/researchers and published literature; however, it did not incorporate perspectives of teens or parents. Therefore, we conducted in-depth interviews with teens and parents and synthesized present findings with the prior analysis to develop a more encompassing definition and model.

Excitatory and inhibitory neuronal circuits in the spinal cord and their role in the control of motor neuron function and degeneration.

The complex neuronal networks of the spinal cord coordinate a wide variety of motor functions, including walking, running and voluntary and involuntary movements. This is accomplished by different groups of neurons, called center pattern generators, which control left-right alternation and flexor-extensor patterns. These spinal circuits, located in the ventral horns, are formed by several neuronal types, and the specific function of most of them has been identified by means of studies in vivo and in the isolated spinal cord of mice harboring genetically induced ablation of specific neuronal populations. These studies have shown that the coordinated activity of several interneuron types, mainly GABAergic and glycinergic inhibitory neurons, have a crucial role in the modulation of motor neurons activity that finally excites the corresponding muscles. A pharmacological experimental approach by administering in the spinal cord agonists and antagonists of glutamate, GABA, glycine and acetylcholine receptors to alter their synaptic action has also produced important results, linking the deficits in the synaptic function with the resulting motor alterations. These results have also increased the knowledge of the mechanisms of motor neuron degeneration, which is characteristic of diseases such as amyotrophic lateral sclerosis, and therefore open the possibility of designing new strategies for the prevention and treatment of these diseases.

Comparison of Outpatient Medically Attended and Community Level Influenza-like Illness - New York City, 2013-2015.

Surveillance of influenza-like illness (ILI) in the United States is primarily conducted through medical settings despite a significant burden of non-medically attended ILI.

Pretreatment of ferulic acid attenuates inflammation and oxidative stress in a rat model of lipopolysaccharide-induced acute respiratory distress syndrome.

Acute respiratory distress syndrome (ARDS) is a fatal clinical condition that can be caused by pulmonary and non-pulmonary diseases. Oxidative stress and inflammation play key roles in the development of ARDS. In this study, we investigated whether ferulic acid (FA), an anti-oxidant, was beneficial for prophylaxis of ARDS. We established an ARDS rat model using lipopolysaccharide (LPS) administration. Lung injury was assessed by lung wet/dry ratio and broncho-alveolar lavage fluid (BALF) analysis. Hematoxylin and eosin staining was performed to evaluate the histological changes of the lungs. Enzyme-linked immunosorbent assay (ELISA) and immunoblotting were performed to detect proteins in BALF and lung tissue, respectively. Pulmonary function was determined by testing the oxygen level in BALF. FA pretreatment significantly alleviated LPS-induced pulmonary histological changes. FA reversed LPS-induced changes of lung wet/dry ratio, total protein in BALF, P(A-a)O2, and PaO2/FiO2. In addition, LPS dramatically up-regulated the secretion of interleukin (IL)-1β, IL-6, tumor necrosis factor (TNF)-α, and IL-10 in BALF ( P < 0.01). However, pretreatment of FA significantly improved LPS-induced inflammation. We found that FA indeed reduced oxidative stress in the lungs by testing malondialdehyde level, myeloperoxidase level, and total anti-oxidant capacity. We also proved that FA inactivated multiple mitogen-activated protein kinase signaling pathways in the lungs. In conclusion, FA alleviated LPS-induced ARDS through its anti-inflammatory and anti-oxidant activities.

Ultrasensitive detection of Shiga toxin 2 and its variants in Shiga toxin-producing Escherichia coli strains by a time-resolved fluorescence immunoassay.

A rapid and sensitive two-step time-resolved fluorescence immunoassay (TRFIA) was developed for the detection of Shiga toxin 2 (Stx2) and its variants in Shiga toxin-producing Escherichia coli (STEC) strains. In sandwich mode, a monoclonal antibody against Stx2 was coated on a microtiter plate as a capture antibody. A tracer antibody against Stx2 labeled with europium(III) (Eu3+ ) chelate was then used as a detector, followed by fluorescence measurements using time-resolved fluorescence. The sensitivity of Stx2 detection was 0.038 ng/ml (dynamic range, 0.1-1000 ng/ml). The intra- and inter-assay coefficients of variation of the assay were 3.2% and 3.6%, respectively. The performance of the established assay was evaluated using culture supernatants of STEC strains, and the results were compared to those of a common HRP (horseradish peroxidase) labeling immunosorbent assay. A polymerase chain reaction (PCR) for the detection of genes encoding Stx1 and Stx2 was used as the reference for comparison. Correlation between the Stx2-specific TRFIA and PCR was calculated by the use of kappa statics, exhibiting a perfect level of agreement. The availability of the sensitive and reliable Stx2-specific TRFIA method for quantifying Stx2 and its variants in STEC strains will complement bacteria isolation-based platform and aid in the accurate and prompt diagnosis of STEC infections.

Diagnoses and ordering practices driving blood demand for treatment of anemia in Tanzania.

Resource-limited countries in Africa experience blood shortages. Understanding clinical drivers of blood demand can inform strategies to increase blood availability.

Is it possible to improve compliance in hypertension and reduce therapeutic inertia of physicians by mandatory periodical examinations of workers?

Due to high prevalence, insufficient recognition and ineffectual treatment, hypertension (HT) still remains a major medical and socio-economic problem. There is a real necessity to develop effective prophylaxis for cardiovascular disorders (CVD), based on strategies which support compliance during long-term therapy. The Polish scheme of occupational health services (OHS) with mandatory periodical employee check-ups creates a unique opportunity for effective HT prophylaxis. As a result visiting a doctor is required not only due to health ailments but also by law, which is especially important for those feeling well. It enables an improvement in tertiary prevention, including actions taken not only by the doctors of the OHS, but also by the physicians in charge of treating the patients.

Containment of Highly Pathogenic Avian Influenza A(H5N1) Virus, Lebanon, 20161.

A preparedness plan for avian influenza A(H5N1) virus infection was activated in Lebanon in 2016 after reported cases in poultry. Exposed persons were given prophylaxis and monitored daily. A total of 185 exposed persons were identified: 180 received prophylaxis, 181 were monitored, and 41 suspected cases were reported. All collected specimens were negative for virus by PCR.

A boy with involuntary movements.

A 12-year-old Dutch boy came to the paediatrician with involuntary movements of the right half of his body. He was diagnosed with Sydenham chorea as a consequence of acute rheumatic fever. Acute rheumatic fever is a rare disease in Western countries and should be recognised in time. Antibiotic prophylaxis is indicated in patients who have had acute rheumatic fever, at least until the age of 40.

Blue Monday Is Real for Suicide: A Case-Control Study of 188,601 Suicides.

Many studies have reported that suicides tend to occur on Mondays. However, owing to a lack of controls, conclusive findings on the potential effects of a day of the week on suicides have been lacking. We analyzed public data for causes of death from 1997 to 2015 in the Republic of Korea. Accidental death was used as a control group. The probability of suicide on each day of the week according to age group was calculated. A total of 377,204 deaths (188,601 suicides and 188,603 accidental deaths) were used. The frequency of suicide was highest on Monday and decreased throughout the week until Saturday. Accidental death was highest on Saturday and showed no variations according to weekday. For people in their teens and 20s, the probabilities of suicide on Monday were 9% and 10% higher, respectively, than those on Sunday. As age increased, the differences in suicide probability according to the day of the week were attenuated. The so-called Blue Monday effect is real, particularly for people in their teens and 20s. Suicide prevention strategies that aim to attenuate the burden and stress of Mondays should be planned.

Caspase-1-Mediated Pyroptosis of the Predominance for Driving CD4Formula: see text T Cells Death: A Nonlocal Spatial Mathematical Model.

Caspase-1-mediated pyroptosis is the predominance for driving CD4[Formula: see text] T cells death. Dying infected CD4[Formula: see text] T cells can release inflammatory signals which attract more uninfected CD4[Formula: see text] T cells to die. This paper is devoted to developing a diffusive mathematical model which can make useful contributions to understanding caspase-1-mediated pyroptosis by inflammatory cytokines IL-1[Formula: see text] released from infected cells in the within-host environment. The well-posedness of solutions, basic reproduction number, threshold dynamics are investigated for spatially heterogeneous infection. Travelling wave solutions for spatially homogeneous infection are studied. Numerical computations reveal that the spatially heterogeneous infection can make [Formula: see text], that is, it can induce the persistence of virus compared to the spatially homogeneous infection. We also find that the random movements of virus have no effect on basic reproduction number for the spatially homogeneous model, while it may result in less infection risk for the spatially heterogeneous model, under some suitable parameters. Further, the death of infected CD4[Formula: see text] cells which are caused by pyroptosis can make [Formula: see text], that is, it can induce the extinction of virus, regardless of whether or not the parameters are spatially dependent.

BodiMojo: Efficacy of a Mobile-Based Intervention in Improving Body Image and Self-Compassion among Adolescents.

Mobile interventions promoting positive body image are lacking. This study presents a randomized controlled evaluation of BodiMojo, a mobile application (app) intervention grounded in self-compassion to promote positive body image. A sample of 274 adolescents, mean (SD) age = 18.36 (1.34) years, 74% female, were allocated to a control group or used BodiMojo for 6 weeks. Appearance esteem, body image flexibility, appearance comparison, mood, and self-compassion were assessed at baseline, 6, and 12 weeks. Significant time by group interactions emerged for appearance esteem and self-compassion, with appearance esteem and self-compassion increasing in the intervention relative to the control group. These findings provide preliminary support for BodiMojo, a cost-effective mobile app for positive body image.

HBeAg induces the expression of macrophage miR-155 to accelerate liver injury via promoting production of inflammatory cytokines.

Activation of Kupffer cells (KCs) induced that inflammatory cytokine production plays a central role in the pathogenesis of HBV infection. The previous studies from our and other laboratory demonstrated miRNAs can regulate TLR-inducing inflammatory responses to macrophage. However, the involvement of miRNAs in HBV-associated antigen-induced macrophage activation is still not thoroughly understood. Here, we evaluated the effects and mechanisms of miR-155 in HBV-associated antigen-induced macrophage activation. First, co-culture assay of HepG2 or HepG2.2.15 cells and RAW264.7 macrophages showed that HepG2.2.15 cells could significantly promote macrophages to produce inflammatory cytokines. Furthermore, we, respectively, stimulated RAW264.7 macrophages, mouse primary peritoneal macrophages, or healthy human peripheral blood monocytes with HBV-associated antigens, including HBcAg, HBeAg, and HBsAg, and found that only HBeAg could steadily enhance the production of inflammatory cytokines in these cells. Subsequently, miRNAs sequencing presented the up- or down-regulated expression of multiple miRNAs in HBeAg-stimulated RAW264.7 cells. In addition, we verified the expression of miR-155 and its precursors BIC gene with q-PCR in the system of co-culture or HBeAg-stimulated macrophages. Meanwhile, the increased miR-155 expression was positively correlation with serum ALT, AST, and HBeAg levels in AHB patients. Although MAPK, PI3K, and NF-κB signal pathways were all activated during HBeAg treatment, only PI3K and NF-κB pathways were involved in miR-155 expression induced by HBeAg stimulation. Consistently, miR-155 over-expression inhibited production of inflammatory cytokines, which could be reversed by knocking down miR-155. Moreover, we demonstrated that miR-155 regulated HBeAg-induced cytokine production by targeting BCL-6, SHIP-1, and SOCS-1. In conclusion, our data revealed that HBeAg augments the expression of miR-155 in macrophages via PI3K and NF-κB signal pathway and the increased miR-155 promotes HBeAg-induced inflammatory cytokine production by inhibiting the expression of BCL-6, SHIP-1, and SOCS-1.

Understanding Who Benefits from Parenting Interventions for Children's Conduct Problems: an Integrative Data Analysis.

Parenting interventions are an effective strategy to reduce children's conduct problems. For some families, that is, not all families benefit equally. Individual trials tend to be underpowered and often lack variability to differentiate between families how benefit less or more. Integrating individual family level data across trials, we aimed to provide more conclusive results about often presumed key family (parental education and ethnic background) and child characteristics (problem severity, ADHD symptoms and emotional problems) as putative moderators of parenting intervention effects. We included data from 786 families (452 intervention; 334 control) from all four trials on the Incredible Years parenting intervention in The Netherlands (three randomized; one matched control). Children ranged between 2 and 10 years (M = 5.79; SD = 1.66). Of the families, 31% had a lower educational level and 29% had an ethnic minority background. Using multilevel regression, we tested whether each of the putative moderators affected intervention effects. Incredible Years reduced children's conduct problems (d = - .34). There were no differential effects by families' educational or ethnic background, or by children's level of ADHD symptoms. Children with more severe conduct problems and those with more emotional problems benefited more. Post hoc sensitivity analyses showed that for the two trials with longer-term data, moderation effects disappeared at 4 or 12 months follow-up. Often assumed moderators have some, but limited abilities to explain who benefits from parenting interventions. This suggests the need for studying theoretically more precise moderators in prevention research, other than relatively static family characteristics alone.

An 18-cm unruptured abdominal aortic aneurysm.

Abdominal aortic aneurysm (AAA) is a significant source of morbidity and ranked by the Centers for Disease Control and Prevention as the 15th leading cause of death among adults aged 60 to 64 years. Size confers the largest risk factor for aneurysm rupture, with aneurysms >6 cm having an annual rupture risk of 14.1%. We present the case of a 60-year-old man found on ultrasound imaging at a health fair screening to have a 15-cm AAA. Follow-up computed tomography angiography revealed an 18-cm × 10-cm unruptured, infrarenal, fusiform AAA. Giant AAAs, defined as >11 cm, are rarely described in the literature. Our patient underwent successful transperitoneal AAA repair with inferior mesenteric artery reimplantation and was discharged home on operative day 6. We believe this case represents one of the largest unruptured AAAs in the literature and demonstrates the feasible approach for successful repair.

Worldviews and trust of sources for health information on electronic nicotine delivery systems: Effects on risk perceptions and use.

Public health agencies, the news media, and the tobacco/vapor industry have issued contradictory statements about the health effects of electronic nicotine delivery systems (ENDS). We investigated the levels of trust that consumers place in different information sources and how trust is associated with cultural worldviews, risk perceptions, ENDS use, and sociodemographic characteristics using a nationally representative sample of 6051 U.S. adults in 2015. Seventeen percent of adults were uncertain about their trust for one or more potential sources. Among the rest, the Centers for Disease Control and Prevention (CDC), health experts, and the Food & Drug Administration (FDA) elicited the highest levels of trust. In contrast, tobacco and vapor manufacturers, vape shop employees, and, to a lesser extent, the news media were distrusted. Adults who had higher incomes and more education or espoused egalitarian and communitarian worldviews expressed more trust in health sources and the FDA, whereas those identifying as non-Hispanic Black or multiracial reported less trust. Current smokers, those who identified as non-Hispanic Black or other race, had lower incomes, and espoused hierarchy and individualism worldviews expressed less distrust toward the tobacco and vapor industry. Greater trust (or less distrust) toward the tobacco and vapor industry and an individualism worldview were associated with perceptions of lower risk of premature death from daily ENDS use, greater uncertainty about those risks, and greater odds of using ENDS. Public health and the FDA should consider consumer trust and worldviews in the design and regulation of public education campaigns regarding the potential health risks and benefits of ENDS.

Incorporating biomarkers into the study of socio-economic status and health among older adults in China.

The social gradient in health - that individuals with lower SES have worse health than those with higher SES- is welldocumented using self-reports of health in more developed countries. Less is known about the relationship between SES and health biomarkers among older adults residing in less developed countries. We use data from the ChineseLongitudinal Healthy Longevity Survey (CLHLS) longevity areas sub-sample to examine the social gradient in healthamong rural young-old and oldest-old adults (N=2,121). Our health indicators include individual biomarkers, metabolic syndrome, and self-reports of health. We found a largely positive relationship between SES and health. SES was more consistently associated with individual biomarkers among the oldest-old than the young-old, providing evidence for cumulative disadvantage. We discuss the implications of our findings for older adults who have lived through different social, economic, and health regimes.

Explaining racial/ethnic differences in all-cause mortality in the Multi-Ethnic Study of Atherosclerosis (MESA): Substantive complexity and hazardous working conditions as mediating factors.

Research on racial/ethnic health disparities and socioeconomic position has not fully considered occupation. However, because occupations are racially patterned, certain occupational characteristics may explain racial/ethnic difference in health. This study examines the role of occupational characteristics in racial/ethnic disparities in all-cause mortality. Data are from a U.S. community-based cohort study (n=6342, median follow-up: 12.2 years), in which 893 deaths (14.1%) occurred. We estimated mortality hazard ratios (HRs) for African Americans, Hispanics, and Chinese Americans compared with whites. We also estimated the proportion of the HR mediated by each of two occupational characteristics, substantive complexity of work (e.g., problem solving, inductive/deductive reasoning on the job) and hazardous conditions (e.g., noise, extreme temperature, chemicals), derived from the Occupational Information Network database (O*NET). Analyses were adjusted for age, sex, nativity, working status at baseline, and study sites. African Americans had a higher rate of all-cause death (HR 1.41; 95% confidence interval [CI]: 1.19-1.66) than whites. Chinese-American ethnicity was protective (HR 0.59, CI: 0.40-0.85); Hispanic ethnicity was not significantly different from whites (HR 0.88; CI: 0.67-1.17). Substantive complexity of work mediated 30% of the higher rate of death for African Americans compared with whites. For other groups, mediation was not significant. Hazardous conditions did not significantly mediate mortality in any racial/ethnic group. Lower levels of substantive complexity of work mediate a substantial part of the health disadvantage in African Americans. This job characteristic may be an important factor in explaining racial health disparities.

A comprehensive analysis of the mortality experience of hispanic subgroups in the United States: Variation by age, country of origin, and nativity.

Although those identifying as "Hispanic or Latino" experience lower adult mortality than the more socioeconomically advantaged non-Hispanic white population, the ethnic category Hispanic conceals variation by country of origin, nativity, age, and immigration experience. The current analysis examines adult mortality differentials among 12 Hispanic subgroups by region of origin and nativity, and non-Hispanic whites, adjusting for socioeconomic and demographic characteristics. We use the National Health Interview Survey Linked Mortality Files pooled 1990-2009 to obtain sufficient sample of each subgroup to calculate mortality estimates by sex and age group (25-64, 65+). Among adults aged 65 and over, all foreign born subgroups have an advantage over non-Hispanic whites, and many USB subgroups exhibit an advantage in the adjusted model. Foreign-born Dominicans, Central/South Americans, and other Hispanics exhibit consistent advantages across models for both men and women, aged 25-64 and 65 and over, and both unadjusted and adjusted for socioeconomic covariates. Both US-born and foreign-born Mexicans between ages 25 and 64 have mortality disadvantaged relative to non-Hispanic whites, while older Mexicans exhibit clear advantages. Our results complicate the traditional formulation of the Hispanic Paradox and cast doubt on the singularity of the mortality experience of those of Hispanic origin.

Comparison of HIV Testing among Children and Adults with Tuberculosis, Vietnam.

HIV testing among persons with tuberculosis (TB) results in high-yield identification of persons infected with HIV. To evaluate differences in HIV testing among children versus adults with TB in Vietnam, we collected and analyzed age-disaggregated facility and aggregated provincial data from the National Tuberculosis Program. HIV testing was incompletely documented for >70% of children, whereas adult testing data were >90% complete. Standardized training of personnel for universal HIV testing and documentation for children with TB could improve HIV case-detection and permit linking of children with HIV to antiretroviral treatment to prevent morbidity and mortality.

Curative versus palliative treatments for colorectal cancer with peritoneal carcinomatosis: a systematic review and meta-analysis.

The objective of this study was to provide an up-to-date summary of the current evidence that may be useful for updating guidelines. We comprehensively searched the published literatures and conferences for studies that compared curative with palliative treatments in colorectal cancer patients with peritoneal metastasis. The primary outcomes considered in this study were three- and five-year overall survival rates. We pooled data across studies and estimated summary effect sizes. Overall, patients who received curative treatments had improved three-year survival (hazard ratio (HR), 2.19 [95% CI, 1.83 to 2.62]) and five-year survival (HR, 2.22 [95% CI, 1.83 to 2.69]) compared with those who received palliative treatments. Patients who received curative treatments had an increased risk of treatment-related morbidity (odds ratio (OR), 2.90 [95% CI, 2.02 to 4.17]), but there was no significant difference in treatment-related mortality between patients who received curative treatments and those who received palliative treatments (OR, 1.46 [CI, 0.62 to 3.47]). Curative treatments improved overall survival in colorectal cancer patients with peritoneal metastasis and did not increase the risk of treatment-related mortality. Curative treatments were associated with a higher risk of treatment-related morbidity. These data highlight the importance for further investigation aimed at prevention of treatment-associated morbidity.

Radiation therapy for stage IVA uterine cervical cancer: treatment outcomes including prognostic factors and risk of vesicovaginal and rectovaginal fistulas.

To evaluate the safety and efficacy of radiation therapy for stage IVA uterine cervical cancer and to identify an optimal radiation regimen.

Influenza vaccination might reduce the risk of ischemic stroke in patients with atrial fibrillation: A population-based cohort study.

Atrial fibrillation (AF) is associated with the risk of ischemic stroke, regardless of the administration of appropriate antithrombotic prophylaxis. This study investigated whether influenza vaccination is associated with the risk of ischemic stroke, to determine a solution to reduce this risk in patients with AF.