|| An in-Depth Evaluation of Behavioral Disinhibition Associated with Male Circumcision in Kisumu, Kenya: A Nested Longitudinal Analysis
|| Combined effects of Metformin and Exercise on AMPK
a2 Activity and Insulin
||Uninsured Mothers and the Increased Risk of Poor Birth Outcomes: Do Biochemical Markers Play a Role?
||Plasmid-based Rescue of Influenza A Virus Directly from Swab Specimens
||Factors associated with sexual debut and depression among rural Jamaican adolescents
||Endemic Hemolytic Uremic Syndrome in Children in Oklahoma
||Competitive food and beverage environment of one state's largest school district significantly falls short of the Alliance for a Healthier Generation's nutritional criteria
||A lack of improvement in neural tube defect prevalences in California after folate fortification
||Stress, social support and health locus of control as predictors of psychological distress in HIV-infected women
||A report on the Secular Trends and Descriptive Epidemiology of Methicillin Resistant Staphylococcus aureus (MRSA) from an Outpatient Clinic Population in Appalachian Ohio and West Virginia
||Race, Health Literacy, and HIV Medication Adherence
||Analysis of Smoking Cessation Patterns Using a Stochastic Mixed Effects Model with a Latent Cured State
||Medicaid Family Planning Waiver Participation as Related to Birth to Conception Intervals
||Induction of labor and maternal outcomes in multiparous women in a population-based sample
||Counseling about and Use of Emergency Contraception in the United States: Results from the National Survey of Family Growth
||Combining qualitative and quantitative diagnostic tests in the absence of a gold standard--what to do with missing data? GB virus C (GBC-C) viremia as an example
||Utility of Fluorescence Lifetime Imaging Microscopy in the Detection of Atherosclerosis
||Does timing of multivitamin supplementation modify the association between smoking during pregnancy and birth weight?
||Web-Based State Employee Worksite Wellness Program: Nutritional Findings at One-Year Follow-Up
An in-Depth Evaluation of Behavioral Disinhibtion Associated with Male Circumcision in Kisumu, Kenya: A Nested Longitudinal Analysis
Christine L. Mattson, Division of Epidemiology and Biostatistics, School of Public Health University of Illinois at Chicago
Other authors: R.C. Bailey , R. Campbell, S. Moses, K. Agot, J.O. Ndinya-Achola (Division of Epidemiology and Biostatistics, School of Public Health University of Illinois at Chicago)
The results of three randomized controlled trials (RCTs) have now confirmed compelling observational evidence that male circumcision (MC) significantly reduces transmission of heterosexually acquired HIV-1 infection among men. However, concern remains as to whether circumcised men will engage in increased risk behavior after the procedure (i.e. behavioral disinhibition or risk compensation). The purpose of this study was to perform an in-depth evaluation of the sexual behavior among a sub-set of men participating in the RCT in Kenya. Participants were prospectively recruited from the RCT of MC in Kenya to undergo additional in-depth interviews about their sexual behavior within 10 days of enrollment in the RCT and then 6 and 12 months after enrollment. In a prior study we used non-parametric Item Response Theory to develop an 18-item scale to characterize sexual risk behavior. These scores served as the primary outcome variable for this longitudinal analysis of sexual risk behavior. Secondary outcome variables included: number of sexual partners in the last 6 months, number of partners with whom men did not always use a condom with in the last 6 months, and incident infections gonorrhea, chlamydia or trichomonas. Random effects regression models were used to assess changes in sexual risk behavior through time and between circumcised and uncircumcised men. Between March 2004 and September 2005, 1780 men in the parent RCT of MC were eligible to enroll in this study. Of these, 1319 enrolled, yielding an overall response rate of 74%. Seventy-six percent of men returned for the 6 month and 77% returned for the 12 month follow-up visit. We found a significant reduction in sexual risk behavior among both circumcised and uncircumcised men from baseline to 6 (p< 0.01) and 12 months post-enrollment (p< 0.01). There was no evidence of differential risk reduction between circumcised and uncircumcised men 6 or 12 months post-enrollment for the primary or secondary outcome variables. After adjusting for age, marital status, education, income, incidence of an STI, belief that circumcision decreases the risk of HIV, and post-coital cleansing, the effect of circumcision was not statistically significant. Thus, there was no evidence of behavioral disinhibition/risk compensation. When circumcision was provided in the context of a RCT with rigorous risk reduction counseling, it did not result in increased risk behavior. When circumcision is added to the limited armamentarium of current HIV prevention strategies, it should be provided as a part of comprehensive prevention program. Continued monitoring and evaluation of behavioral disinhibition associated with MC is needed as public perception and subsequent behavior may change in the wake of the new evidence supporting the efficacy of male circumcision.
Combined effects of Metformin and Exercise on AMPK a2 Activity and Insulin
Carrie G. Sharoff, University of Massachusetts at Amherst
Other authors: TA Hagobian (UMass Amherst); SR Chipkin (UMass Amherst); H Yu (Joslin Diabetes Center), MF Hirshman (Joslin Diabetes Center); LJ Goodyear (Joslin Diabetes Center); and B Braun (UMass Amherst)
Activation of AMP-activated protein kinase (AMPK) stimulates skeletal muscle glucose transport via insulin-independent mechanisms. Both moderate-intensity exercise and the anti-hyperglycemic drug, metformin, increase skeletal muscle AMPK a2 activity and glucose uptake in individuals with type 2 diabetes. The combined impact of exercise and metformin has not been studied. To assess the combined effect of metformin and moderate-intensity exercise on AMPK a2 activity and whole-body and hepatic insulin action in insulin resistant subjects, muscle AMPKa2 activity and insulin sensitivity were measured in insulin-resistant men (n=4) and women (n=7) at 3 time points: pre-treatment baseline (B), after 2-3 weeks of metformin (2000 mg/day; MET), and after metformin plus one bout of exercise at 65%VO 2 peak (MET+Ex). To assess muscle AMPK activity, vastus lateralis biopsies were taken before treatment with metformin (B), after 2-3wks of metformin treatment (MET), and after 2-3wks metformin treatment + 40min of exercise (MET+Ex). Immediately after the muscle biopsy, [6,6-2H]-glucose was infused for 90min followed by a 2-hr euglycemic hyperinsulinemic (40 mU/m 2 /min) clamp enriched with 2% [6,6 2 H]glucose. Outcomes related to insulin action were glucose rate of disappearance/mean plasma insulin (Rd/I) measured after the first and second hour of the clamp (0-60min and 60-120min respectively), metabolic clearance rate (MCR), and % suppression of basal hepatic glucose production. With MET, there was no change in AMPK a2 activity or MCR but there was a 12% increase in Rd/I at 0-60 min. With MET+Ex, there was a 46% increase in AMPK a2 activity and a 45% increased in Rd/I at 0-60min with no change in MCR. Rd/I was not different from B with MET or MET+Ex at 60-120min. % Hepatic suppression increased 75 and 99% with MET and MET+Ex respectively. Thus, it appears that both MET and MET+Ex increase hepatic insulin sensitivity while only MET+Ex increases AMPK a 2 activity and whole-body insulin sensitivity. Ongoing studies are evaluating the independent effect of exercise on AMPK activity and insulin action.
Uninsured Mothers and the Increased Risk of Poor Birth OUtcomes: Do Biochemical Markers Play a Role?
Avrahom Gurwitz, State University of New York Downstate Medical Center.
About 20% of the US population lacks health insurance. Epidemiological data show that pregnant women without medical insurance have poorer birth outcomes. This study compares blood levels in insured vs. uninsured women of biochemical markers known to affect birth outcomes to determine whether differences can explain the poorer outcomes. Types of insurance and demographic variables were evaluated for confounding. All women of reproductive age in NHANES 1999-2002 (a representative sample of the U.S. population) with data on health insurance status and selected biochemical markers (n = 3,540) were included in this cross sectional study. Outcome Measures consisted of maternal mean RBC folate, serum iron, and total serum mercury. Demographics associated with poorer outcomes were: age (<18 years and >40 years), marital status (unmarried), income (<$14,000), education (< high school) and race/ethnicity (non-Hispanic whites). Controlling for these confounders, the mean folate level (ng/mL) was 286.7 for the insured group and 274.6 for the uninsured group (p = 0.02). The mean iron level (ug/dl) was 85.5 for the insured group and 78.7 for the uninsured group (p = 0.01). Mercury showed no statistically significant difference between the groups. Women with Medicaid had a significantly lower level of folate than women with private insurance or uninsured women (p < 0.01). Mean serum folate and iron levels are lower in uninsured women vs. insured women after controlling for demographic confounders. This difference may partially explain the poorer birth outcomes in uninsured women vs. insured women.
Plasmid-based Rescue of Influenza A Virus Directly from Swab Specimens
Bin Zhou, Department of Biomedical Sciences, SUNY Albany and Division of Infectious Disease, Wadsworth Center, NY State Department of Health
Other authors: Matthew E. Donnelly (SUNY Albany); Rachel A. Hinckley (SUNY Albany); Greta V.S. Jerzak (SUNY Albany); Kirsten St. George (SUNY Albany); and David E. Wentworth (SUNY Albany and NY State Department of Health)
Epidemics of influenza A virus affect 15-60 million people in the US annually, and these infections cause significant morbidity and mortality. Many subtypes of influenza A, which are differentiated on the basis of their hemagglutinin (H1-H16) and neuraminidase (N1-N9) surface glycoproteins, circulate in other species, such as pigs, horses, dogs, seals and most importantly birds. Infrequently, novel influenza A viruses emerge from such reservoirs and give rise to pandemics, in which morbidity and mortality are dramatically increased. The development of plasmid-based reverse-genetic technology, to engineer a negative-sense segmented RNA genome and recover infectious influenza A virus, has revolutionized basic research and shows great promise for vaccine production. Current reverse-genetic systems use restriction digestion and ligation to create clones for each gene segment. To accelerate the rescue of new influenza A viruses for research and vaccine production , we modified the reverse-genetic system (Neumann et al . 1999 ), for recombination-based cloning of the entire influenza A genome, amplified using a multi-segment RT-PCR (M-RTPCR) strategy to simultaneously amplify all eight genomic segments. We used M-RTPCR to amplify the genome of a recent human H3N2 virus (A/NY/238/2005) directly from a clinical swab specimen, and then cloned the amplicons into our recombination-based reverse-genetic plasmids. Clones containing each A/NY/238/2005 gene segment were identified, and used to generate a genetically engineered virus (rA/NY/238/2005). The data show that the combination of M-RTPCR and recombination-based cloning confers sensitivity, speed, fidelity, and flexibility to the rescue of any subtype of influenza A virus, without the need for in vitro propagation. .
Factors associated with sexual debut and depression among rural Jamaican adolescents.
Olaniyi James Ekundayo, Division of Gerontology & Geriatric Medicine, University of Alabama at Birmingham School of Public Health
Factors associated with sexual activity among adolescents in Jamaica has not been well studied. The objective of this study was to identify factors associated with sexual debut and depression among rural Jamaican adolescents. We analyzed data on 748 adolescents. Multivariate logistic regression was used to predict factors associated with sexual experience, early sexual debut, and depressive symptoms. For girls, sexual experience was associated with older age, spending time with boyfriends, and lack of parental monitoring. Living with both biological parents was protective (OR=0.45; 95% CI = 0.30-0.67). For boys being older at time of survey (OR=1.47; 95% CI = 1.07-2.02) and lack of parental monitoring (OR=1.19; 95% CI = 1.01-1.39) were significant predictors. Early sexual debut for girls was influenced by type of partner at first intercourse (OR=11.95; 95% CI = 2.39-59.69) and liberal attitude towards negative sexual outcomes (OR=1.83; 95% CI = 1.21-2.77). Boys, on the other hand, were mostly influenced by liberal attitude towards negative sexual outcomes. Being older at time of survey was protective for both genders. Depressive symptom was associated with being sexually experienced (OR=1.59; 95% CI = 1.00-2.52) and lack of maternal support (OR=4.06; 95% CI = 2.61-6.32 ). Education programs that will delay initiation of sexual activity need to start early before adolescents become sexually active. As most homes are female-headed, establishing support systems for the mother to take care of their adolescent children may decrease the odds of depressive symptoms .
Endemic Hemolytic Uremic Syndrome in Children in Oklahoma
Charity Karpac, Department of Health Administration and Policy and Department of Medicine, University of Oklahoma.
The objective was to characterize the epidemiology, clinical characteristics, treatment, and outcomes of hemolytic uremic syndrome in children in Oklahoma . Hemolytic uremic syndrome (HUS) is the most common cause of acute renal failure in children worldwide, and is defined by a triad of microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure. Typical HUS is characterized by a prodrome of diarrhea (often bloody) that is caused by a Shiga-toxin producing organism such as Escherichia coli 0157:H7. Recent E.coli 0157:H7outbreaks causing HUS have received great media attention. However, the majority of cases of HUS may be endemic, not associated with an identified outbreak. All patients at Children's Hospital of Oklahoma from 2003-2005 with an ICD-9 discharge code of 283.11 (HUS) were identified. Medical records were available and evaluated for 18 of 19 patients. Cases occurred in all three years of the study: eight in 2003, four in 2004, and six in 2005. The average age of these patients was 4.4 years, 13 were female, and 12 were Caucasian. Sixteen patients had a diarrhea-prodrome; in 13 the diarrhea was bloody. E.coli 0157:H7 was isolated from only four of the patients' stool samples. Ten patients required dialysis; five patients were treated with plasma exchange therapy. All survived. Endemic HUS accounted for all cases in children in Oklahoma from 2003-2005, and is an important cause of childhood morbidity.
Competitive food nad beverage environment of one state's largest school distrcit significantly falls short of the Alliance for a Healthier Generation's nutritional criteria
Karen Schliep, University of Utah, DFPM Public Health Program
The purpose of this study is to evaluate the competitive food and beverage environment of Utah 's largest school district using the Alliance for a Healthier Generation's (AFHG) nutritional guidelines. With the data collected the year prior to the adoption of the USDA mandated School Wellness Policy, the assessment serves as a good baseline from which to measure progress in implementing nutritional standards for competitive foods. Food and beverage inventories of all vending machine and a la carte lunch items in Jordan School District were conducted. 8067 items were recorded. Nutrition analysis was performed on all the unique food (n=328) and beverage (n=122) items. Unique foods were grouped into food (n = 14) and beverage (n = 8) categories using the AFHG outline and comparisons were made between nutritional content of district's foods and recommendations from AFHG. Snacks including baked goods, bars, candy, chips and crackers (48.8%) followed by regular (non-diet) soda pop (16.5%) made up the majority of district foods. The AFHG recommends that snacks must provide no more than 35% calories from total fat, no more than 10% of calories from saturated fat, and be no more than 35% sugar by weight. Snack means exceed AFHG guidelines for total fat calories (mean = 31.3%), saturated fat calories (mean = 11.5%) and for sugar by weight (mean = 40.7%). AFHG recommends that no sodas over 10 calories per 8 ounce be offered in the high schools. Regular soda mean was 306.2 calories.
A lack of improvement in neural tube defect prevalences in California after folate fortification
Brian Chen, MPH, University of California at Los Angeles.
Other authors: Suzan L. Carmichael, PhD; Steve Selvin, PhD; Barbara Abrams, DrPH; and Gary M. Shaw, DrPH.
Numerous studies have demonstrated declining neural tube defect (NTD) prevalences as a result of folic acid fortification, which began in 1998. The majority of these studies evaluate the effectiveness of folic acid fortification by comparing pre-fortification and post-fortification prevalences; however, these findings may be an artifact of a declining background trend. The aim of this study was to determine whether NTD prevalences decreased more rapidly after fortification (1998-2003) than before fortification (1989-1996) after accounting for pre-existing trends. The study population included all live births and stillbirths delivered in central California counties from 1989 to 2003. Cases included pregnancies with NTDs identified by birth defects surveillance during the same time period. Using weighted least squares regression, we compared the rate of change (i.e. slope of the line) in NTD prevalences in the periods before and after fortification. For comparison, pre- and post-fortification period prevalences were also assessed. For all NTDs combined, the pre-fortification slope indicated that NTD prevalence decreased by 7.8 (slope: -7.8; 95% CI: -11.4, -4.2) cases per 100,000 deliveries per year, while the post-fortification slope increased by 5.0 (slope: 5.0; 95% CI: -2.5, 12.6) cases per 100,000 deliveries per year. A comparison of the pre- (85.23 cases per 100,000 deliveries) and post-fortification (post-fortification=72.16 cases per 100,000 deliveries) period prevalences suggested a beneficial effect from fortification. In conclusion, after accounting for the background trend, annual NTD prevalences did not decrease more rapidly after implementation of folic acid fortification; this finding contradicts previous findings that do not account for pre-existing trends.
Stress, social support and health locus of control as predictors of psychological distress in HIV-infected women
Ahnalee Brincks, Florida International University Robert Stempel School of Public Health.
Other author: Nicole Kelliher
Studies have shown factors such as stress, social support and health locus of control (HLOC) influence psychological distress. The purpose of this study was to investigate the effects of stress, social support and HLOC on psychological distress among HIV-positive minority women. Fifty-eight HIV-positive, minority (81% African-American, 12% Hispanic) women who successfully completed a drug rehabilitation program were recruited for a longitudinal study at two major universities in south Florida . The present study used multiple linear regression for cross-sectional analysis of baseline data to determine model fit and independent effects of predictor variables. The goal was to examine the relationship between predictors and the continuous outcome variable psychological distress, indicated by the Global Severity Index score on the Brief Symptom Inventory. The overall model was significant at p < .001 ( R 2 = .343). Stress and ‘powerful others' HLOC were both statistically and positively associated with psychological distress ( p < .01; p < .05). Social support, internal HLOC and chance HLOC were not significant. This study replicated findings that stress affects psychological distress for HIV-positive individuals. ‘Powerful others' HLOC is a belief that health status is influenced by the behavior of external, powerful individuals (e.g. medical professionals). Previous studies have shown an association between external HLOC and worse health outcomes in the face of disease. The importance of medical professionals for HIV-positive individuals makes the ‘powerful others' finding particularly salient. Finally, this study documents the relationship of HLOC to distress in a more diverse population than prior research.
A Report on the Secular Trends and Descriptive Epidemiology of Methicillin-Resistant Staphylococcus aureus (MRSA) from an Outpatient Clinic Population in Appalachian Ohio and West Virginia
Jonah Long, Consortium of Eastern Ohio Master of Public Health
Methicillin-resistant Staphylococcus aureus (MRSA) is a common antibiotic resistant pathogen and a significant public health problem worldwide. Infections due to MRSA have historically involved nosocomial transmission, but over the past decade, reports of community transmission of MRSA have increased considerably. Despite this fact, reports describing the extent of MRSA in rural communities are limited. Secular trends were analyzed for all methicillin-sensitive S. aureus (MSSA) and MRSA-positive cultures analyzed at a large outpatient clinic laboratory with clinic branches throughout Southeastern Ohio and Western West Virginia from January 1, 2000 to December 31, 2005. In addition, the descriptive epidemiology for all MRSA-positive specimens collected during the study period was summarized. Of 1,368 outpatient cultures with S. aureus identified from 2000 – 2005, 525 (38.4%) were determined to be MRSA. Overall, the proportion of all S. aureus cultures identified as MRSA increased significantly from 20.0% in 2000 to 64.0% in 2005 (p<0.01). Furthermore, the proportion of positive MRSA cultures in persons <20 years old (p<0.01) and from wound specimens (p<0.01) also increased significantly during the study period. Concurrent secular decreases were noted among the proportion of positive MRSA cultures in persons older than 60 years and from urine cultures. This study identified dramatic increases in the proportion of MRSA-positive wound cultures in young persons seeking care at large outpatient clinics in rural Appalachian Ohio and West Virginia . The findings are consistent with recent studies conducted in other geographic regions that indicate large increases in community-associated MRSA infections.
Race, Health Literacy, and HIV Medication Adherence
Chandra Osborn, Northwestern University Master of Public Health Program
Limited health literacy may contribute to racial disparities in health. This study examined the mediating effect of limited health literacy on the relationship between race and HIV medication adherence. A total of 204 patients infected with HIV were recruited from two clinics. Structured in-person interviews were conducted to obtain information on patient demographics, medication adherence, and health literacy. Multivariate regression models examined the associations between race, literacy, and HIV medication adherence after adjusting for relevant covariates. In an adjusted analysis that excluded literacy, African Americans were 2.40 times more likely to be non-adherent to their HIV medication regimen than Whites. When literacy was included in the final model, the effect estimates of race diminished 25% to non-significance. Literacy remained a significant independent predictor of non-adherence. In this study, limited health literacy mediated the relationship between race and HIV medication adherence. I nvestigators need to consider the potential utility of ameliorating literacy barriers in healthcare as part of interventions to reduce racial health disparities. The development of educational interventions for medication management that are both appropriate for lower literate audiences and culturally sensitive may both improve HIV medication adherence, and reduce racial disparities on this outcome.
Analysis of Smoking Cessation Patterns Using a Stochastic Mixed Effects Model with a Latent Cured State
Sheng Luo, Johns Hopkins University Bloomberg School of Public Health
Smoking is a major cause of a large number of diseases, e.g. cancers of the lung, larynx, and pharynx, etc. The slow reduction of adult smoking prevalence is partly due to high rates of relapse following quit attempts among smokers. A major problem when studying smoking addiction behavior is that participants make several quit attempts before successfully quit. For efficient development, targeting and evaluation of interventions, it is necessary to distinguish transient quitting (temporarily smoking-free but relapse later) from permanent quitting (lifelong smoking-free). We identified and quantified baseline factors associated with permanent quitting using the Alpha-Tocopherol Beta-Carotene (ATBC) Lung Cancer Prevention study dataset (a longitudinal cohort study with 29133 subjects). We modeled the smoking cessation patterns using the discrete-time stochastic mixed-effect model with three states: smoking, transient quitting and permanent quitting. We also designed computationally practical methods for dealing with the size of the data set and complexity of the models. We found that age was positively associated with probability of making quit attempts (p<0.001). However, years of smoking, cigarette and alcohol consumption had inverse association with probability of making quit attempt (p<0.001). If the quit attempt was made, more alcohol consumption per day was associated with higher probability of relapsing (p=0.005). Moreover, 5 years in age increased the odds of permanent quitting by 10.2% (CI -0.40%~21.8%; p=0.06). Individuals with psychological symptoms were significantly less likely to be successful permanent quitters (p=0.03). Thus, baseline risk factors had different effects on different transition probabilities.
Medicaid Family Planning Waiver Participation as Related to Birth to Conception Intervals
Kim Nichols Dauner, MPH, University of South Carolina Arnold School of Public Health
Women with a short BCI at risk for delivering low birth weight, preterm, and small for gestational age infants. Women with a short BCI are also more likely to have an unplanned pregnancy. These risks are greater among low-income women. Medicaid family planning waivers help low-income women access reproductive health services by expanding the population eligible for services. In the 25 states with waivers, evidence suggests they have increased the number of women getting contraception, improved contraceptive use, and are cost-effective. However, there has been little research into how long-term participation affects health outcomes such as BCI. Using an ecological framework, analysis of covariance was used to evaluate the relationship between family planning waiver participation and BCI. The study population included all women enrolled in the South Carolina waiver during July 1994-June 2003, excluding women who have not given birth and women who gave birth within 36 months of waiver enrollment (so that variation in service utilization before the first birth could be evaluated). Adjusting for demographic and behavioral covariates, there was a positive and significant (p<0.01) relationship between the total number of family planning visits and BCI. Data indicate that greater utilization of family planning services translates to a longer BCI. It is important that policy evaluations move beyond process measures to provide behavioral change and health outcomes data to determine whether policy is an appropriate intervention. These findings support the intervention effect of this policy and underscore the need to expand this policy nationwide.
Induction of labor and maternal outcomes in multiparous women in a population-based sample
Rebecca Bryan, Saint Louis University
Induction of labor is associated with increased risks of cesarean section and vaginal birth with instrumentation (vacuum or forceps) in nulliparous women. Less is known about the association between induction of labor and cesarean section and vaginal birth with instrumentation among multiparous women. A population-based cohort study was conducted using Missouri Maternally Linked Cohort data from 1989 to 1997. The study sample included 49,915 second time mothers with singleton birth at 37-41 weeks gestation, without medical or obstetrical complications, or previous cesarean section. The primary exposure was induction of labor and outcomes were cesarean section and vaginal delivery with instrumentation. Multivariate logistic regression models were used to estimate the risk association using crude and adjusted odds ratios, controlling for characteristics related to induction of labor and cesarean section. Study observed a 31% (95%CI:1.14-1.50) and 45% (95%CI:1.34-1.57) increase in likelihood of cesarean section and vaginal birth with instrumentation, respectively, in women whose labors were induced compared to women whose labors were not. After adjusting for covariates the risk of cesarean section was 22% (95%CI:1.06-1.41) higher and the risk of vaginal birth with instrumentation was 35% (95%CI:1.24-1.46) higher in women whose labors were induced compared to women who were not induced. Induction of labor is associated with an increased risk of cesarean section and vaginal birth with instrumentation in multiparous women after controlling for covariates.
Counseling about and Use of Emergency Contraception in the United States: Results from the National Survey of Family Growth
Megan L. Kavanaugh, MPH, University of Pittsburgh Graduate School of Public Health
Other author: Eleanor B. Schwarz, MD, University of Pittsburgh Medical Center, Division of General Internal Medicine
The aims of this study were to estimate the prevalence of counseling about and use of EC and to identify characteristics associated with EC use among reproductive aged women in the US. We analyzed data collected from 7643 US women aged 15-44 by the 2002 National Survey of Family Growth (NSFG) using multivariable models that accounted for multistage probability sampling. In 2001, 3.8% of all respondents reported that their clinician discussed EC and 4.2% reported ever having used EC. Few women (7%) who received a pelvic exam in the last year reported that their doctor had discussed EC. In multivariable analyses, women were more likely to receive counseling about EC if they were younger, Hispanic, Black, and ever married. Women who had been counseled about EC in the last 12 months were significantly more likely to have ever used EC. Few clinicians routinely counsel women about EC despite US women's increased likelihood of using EC if they discussed it with a clinician. Given women's low frequency of EC use, ongoing efforts are needed to raise awareness and knowledge of EC among clinicians and women. EC has the potential to significantly decrease unintended pregnancies and abortions. Clinicians play a pivotal role in ensuring that women have information and access to EC. As the first to describe women's receipt of EC counseling on a national level, this study should encourage clinicians to increase EC discussion with all reproductive aged women.
Combining qualitative and quantitative diagnostic tests in the absence of a gold standard--what to do with missing data? GB virus C (GBC-C) viremia as an example
Suhong Zhang, Department of Biostatistics College of Public Health , The University of Iowa
Other authors: Kathryn Chaloner, Department of Biostatistics College of Public Health, The University of Iowa; and Jack T. Stapleton, Department of Internal Medicine Carver College of Medicine, the University of Iowa and the Iowa City VA Medical Center
Using multiple methods to test for a virus when no standardized test exists introduces several potential sources of variation. We investigated how discrepancies from multiple tests and/or missing data can be evaluated and reconciled statistically. Bayesian Latent Class Analysis was used to model the responses from the different tests. Each qualitative response had three categories (positive, negative, missing) and the quantitative response was divided into four categories (none or low, moderate, high, missing). The model was parameterized by the prevalence of virus, sensitivity and specificity of each test, and probability of each test being missing. A WinBUGS program was developed and used to estimate parameters in the model and to classify each sample. RT-PCR amplification of four GBV-C genome regions (E2, 5'-NTR, NS3 and NS5A) was performed on 381 serum samples from 139 HIV infected subjects: not all tests were run on all samples. Additionally, all samples were tested with a quantitative real-time RT-PCR. GBV-C RNA prevalence based on each single test was 49%, 77%, 78%, and 79% respectively. Under the Bayesian Latent Class Model, the estimated prevalence of GBV-C is 45% in this population; the estimated sensitivities of the four qualitative tests were 92%, 83%, 93%, 99%, and the specificities were 98%, 31%, 32%, 35% respectively. 175 out of 381 samples were classified as positive. Bayesian Latent Class Analysis can be used to evaluate and reconcile different tests in the absence of a gold standard. E2 is the best single test in the GBV-C testing.
Utility of Fluorescence Lifetime Imaging Microscopy in the Detection of Atherosclerosis
Navya Nair, Department of International Health, Tulane University School of Public Health & Tropical Medicine
Atherosclerosis is a chronic disease that is an important public health problem. Early diagnosis of this disease can prevent serious consequences. Fluorescence lifetime imaging microscopy (FLIM) is a new method of imaging that utilizes the intrinsic fluorescence of tissues. In this study, the utility of FLIM in classifying various regions of atherosclerotic plaques was studied as a potential method of early diagnosis. Atherosclerotic plaques from carotid arteries obtained surgically were imaged using FLIM. Regions of the plaque rich in specific substances were classified according to their fluorescence lifetime and the lifetime of each tissue was calculated. Additionally, lifetimes of certain region types within each tissue were calculated. The diverse tissue types identified by FLIM were confirmed by conventional histological methods. The following lifetimes were calculated for various tissue types: Fibrous capsules 989 ± 244 ps ; fibrin rich regions 936 ± 126 ps; lipid rich regions 333 ± 86 ps. Certain runs showed contrast in the FLIM image but not in the intensity image. Histopathology concurrence with FLIM results was 100%. These results support the utility of FLIM for the diagnosis of atherosclerosis. The average lifetimes for fibrin rich and lipid rich regions being significantly different from that of whole tissue has important implications in clinical imaging. It has potential for the detection of macrophage infiltration in atherosclerotic lesions, a key marker of plaque vulnerability. Therefore, FLIM offers a new method of contrast for the diagnosis of atherosclerosis that has wide applicability in clinical preventive medicine.
Does timing of multivitamin supplementation modify the association between smoking during pregnancy and birth weight?
Jaclyn L.F. Bosco, Boston University School of Public Health, Department of Epidemiology
Other author: Martha M. Werler, Boston University School of Public Health and Slone Epidemiology Center
Study results consistently show that babies born to women who smoke during pregnancy are approximately 200 grams (g) lighter than babies of women who do not smoke during pregnancy. However, it is unclear whether multivitamin supplementation can counteract the adverse effects of smoking during pregnancy. We investigated the interaction between smoking and multivitamin supplementation in pregnant mothers on mean birth weight (BW). Data were collected via telephone interviews by nurse interviewers for mothers of singleton births (n=869). Women who smoked 5+ cigarettes/day throughout pregnancy were considered exposed. Initiation of multivitamin supplementation was categorized as early (before or during the 1 st lunar month [LM]), 2 nd LM, 3 rd LM, 4 th LM, later or never, and intermittent. Mean BW was modeled using multiple regression as a function of the dual exposure of smoking and initiation of multivitamins, adjusting for gestational age and mother's age, education, pre-pregnancy body mass index, gravidity, alcohol consumption, family income, marital status, and pregnancy intention. Overall, 7% of mothers smoked during pregnancy and 29%, 38%, 15%, and 5.8% of mothers started multivitamin use early or in the 2 nd LM, 3 rd LM, or 4 th LM, respectively. Babies of smokers had an adjusted mean BW 104g lighter than non-smokers without accounting for multivitamin supplementation. The BW deficit decreased for women whose multivitamin supplementation began in LM3 by 37g, but remained lower for smokers with earlier or later use. Our results suggest that multivitamin supplementation in particular time periods may be beneficial for women who continue to smoke during pregnancy.
Web-Based State Employee Worksite WEllness Program: Nutritional Findings at One-Year Follow-Up
Amanda Philyaw, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences
Other authors: Martha M. Phillips, PhD, MPH, MBA, UAMS and Arkansas Department of Health and Human Services; Carol Cornell, PhD, UAMS; Glen Mays, MPH, PhD, UAMS; and Zoran Bursac, PhD, UAMS
Chronic disease is debilitating the American workforce in the private and public sectors. State or federal agencies and companies bear healthcare cost for ill employees 2 and want to improve worker health, decrease costs, and increase productivity. Chronic diseases attributable to poor nutrition and obesity tremendously impact medical cost and lost productivity. Research suggests that fruit and vegetable intake is associated with lower BMI and reduced risk for developing chronic disease. In Arkansas , the Department of Health and Human Services (DHHS) implemented the Healthy Employee Lifestyle Program (HELP) pilot intervention to encourage comprehensive wellness for state health employees. Employees completed a Health Risk Assessment (HRA) that evaluated nutritional changes, health risk factors, and improvement in Stages of Change at baseline (HRA1) and one-year follow-up (HRA2). Participants were encouraged to practice healthy behaviors, report behaviors using the web-based reporting system, accumulate points for healthy behaviors, and redeem points for incentives (i.e. t-shirt or time off work). We used categorical data methods to analyze differences between HRA1 and HRA2. Consumption of sweets/desserts, fats, protein, grains, processed meats, and dairy did not differ significantly from baseline to follow-up. However, results revealed that from HRA1 to HRA2 more people consumed three or more fruits and vegetables a day and more moved into the action and maintenance Stages of Change. This program successfully encouraged fruit and vegetable consumption and such changes may later contribute to decreased obesity and reduced risk for chronic disease. Though the program is feasible and appears effective, further study is warranted.