An Analysis of Correlation Between Agrichemical Contaminated Wells and Birth Defects in Nebraska

Background: Evidences that agrichemicals might be associated with the incidence of birth defects are inconsistent. Objectives: Examine whether Triazine, Acetanilide, Carbamothioate, Nitrate, Trifluralin and Uracil present in well-water are associated with birth defect rates in Nebraska Counties Identify the well types contaminated with these pesticides. Methods: Birth defects data obtained from Nebraska Department of Human and Health Services were merged with data on wells tested for agrichemicals obtained from Quality-Assessed Agrichemical Contaminant Database for Nebraska Ground Water. The 33 contaminants sampled from the wells were sub classified into 6 predictors and expressed as percentages for analysis in a multiple regression model with birth defect rates as the response variable. The pesticides sampled from the wells were also categorized into parent and degradate to examine the nature of pesticide associated with birth defects. Due to multicollinearity, triazine, acetanilide and trifluralin were summed together. Results The percentage for triazine and nitrate in domestic wells were 10.6% and 21.5% respectively. Birth defect rates were discovered to correlate with triazine (r= 0.21 p=0.041). triazine- acetanilide-trifluralin together was found to be linearly associated with birth defect rates in the multiple linear regression model (p=0.012). A stronger correlation was found between the parent contaminants and birth defect rates(r=0.22 p=0.034) than the degradate. (r=0.15 p=0.163). Conclusion: This study suggests an association between birth defect and percent of wells positive for agrichemical compounds. However, this association does not imply causation but provides direction for future investigation.https://digitalcommons.unmc.edu/coph_pres/1003/thumbnail.jp

Effect of Nitrosamine (NNAT) on Embryogenesis: Evidence from a Study Using Avian Embryos Exposed to NNAT

Background Birth defects are a known cause of infant death in the United States with higher rates in the Midwest perhaps due to higher use of agrichemicals for farm activities. Nitrate and atrazine are two of the most prevalent agrichemicals contaminating drinking water supplies. When ingested together, in the acidic environment of the human stomach, they can react to form a nitrosamine, NNAT. Many nitrosamines are known to be mutagenic, carcinogenic and teratogenic. Significance Preliminary studies have suggested that NNAT is a teratogen and mutagen. Several other agrichemical compounds have been detected in Nebraska groundwater wells that have the potential to nitrosate and studies are underway to evaluate the risk of adverse birth outcomes associated with exposure to these compounds. In this study, we evaluated growth in chick embryos after exposure to NNAT. Hypothesis We hypothesize that the embryo exposed to NNAT would have delayed development compared to unexposed embryos. Experimental design Three groups of eggs were observed in the study: the treatment group was treated with different doses of NNAT dissolved in Dimethyl sulfoxide (DMSO), the vehicle control group were treated with only DMSO and the untreated group (control). The air sac of the treatment groups was injected with varying concentrations of NNAT at one time to stimulate an acute response and at different times for a chronic response. Result/Data: All analysis was done on SAS 9.4. The effect of treatments on the weight and survival of the embryos were determined using analysis of covariance (ANCOVA) and multiple logistic regression respectively. The effect of treatment was found to be significant on the embryo treated with NNAT after adjusting for the effect of the positions of the eggs during incubation (p\u3c0.0001). Embryos that were untreated (controls) had the highest weight (weight=0.34g), and as the dose of NNAT was increased during treatment the weight of the embryo decreased significantly after incubation for 5 days : 0.245 µmol/l of NNAT (weight=0.15g, p=0.0009), 1.11 µmol/l of NNAT (weight=0.13g, p=0.004), 2.22 µmol/l of NNAT (weight=0.11g, p=0.01) and 3.33 µmol/l of NNAT (weight=0.12g, p=0.01). Also, it was found that the odds of survival among the embryo decreased linearly with increased dose when treated with NNAT as compared to the untreated embryos: 1.11 µmol/l of NNAT vs untreated (OR=0.250 95% C.I. 0.078-0.799), 2.22 µmol/l of NNAT vs. untreated (OR=0.120 95% C.I. 0.042-0.347) and 3.33 µmol/l of NNAT vs untreated (OR=0.106 95% C.I. 0.036-0.311) Conclusion: This study has revealed that weight and odds of survival of embryo exposed to NNAT decreased after 5 days of incubation. Dose-effect of the treatment was also observed during the development of embryos exposed to NNAT. Additional studies, however, is needed to evaluate the toxic effects of DMSO on the chick’s embryo before a conclusion can be reached.https://digitalcommons.unmc.edu/coph_pres/1008/thumbnail.jp

Association between recipient’s preexisting antibodies and allograft vasculopathy and mortality in heart transplant patients

Objectives: To evaluate the role of preexisting Angiotensin II receptor type I antibodies (AT1RAb) and anti-HLA antibodies in predicting mortality and cardiac allograft vasculopathy (CAV) among heart transplant patients. Methods: In this retrospective cohort study, we included 114 adults who received heart transplant from January 1st, 2007 to December 31, 2014 and were followed up at Nebraska Medicine. 48 hours pre-transplant sera sample were used to detect antibodies. A cutoff of 10UL/ml was used for AT1RAb positive and mean fluorescence intensity of 3,000 and 1,500 were used for anti HLA class I and class II, respectively. Patients were positive for composite antibodies if they were positive for anti-HLA, or AT1R antibodies. Survival analysis was conducted to compare the risk for mortality or CAV between antibody positive and negative groups. Result: Participants who had positive composite antibodies had higher probability of having CAV (p=0.05). Participants who were negative for AT1RAb trended toward a lower risk of mortality or developing CAV compared to AT1RAb positive counterparts. Conclusion: Positive status for any of anti-HLA or AT1RAb increased the risk of CAV. AT1RAb positivity is possibly linked with higher risk of death or developing CAV. Future study can focus on verifying these trends and the potential interaction effect between anti-HLA and AT1R antibodies

Birth outcomes and water: A multidisciplinary study

Evidence that agrichemicals are associated with the incidence of birth defects is inconsistent. We examined whether nitrate and nitrosatable agrichemicals present in well water are associated with birth defect rates in Nebraska counties. Birth defect data from the Nebraska Department of Health and Human Services, 2005-2014, were merged with well data obtained from the Quality-Assessed Agrichemical Contaminant Database for Nebraska Ground Water (1977-2014). Nebraska counties with higher rates of birth defects had a greater prevalence of agrichemicals in well water. Of the 33 contaminants sampled from different well types, nitrate and atrazine were of interest. Birth defect rates were negatively correlated with nitrate-positive wells and directly correlated with atrazine positive wells. After stratification by well types (domestic and public wells) we found the highest correlation between nitrate+atrazine positive wells as compared to wells contaminated with either nitrate or atrazine. This study suggests stronger association between birth defects and maternal exposure to nitrate+atrazine when compared to maternal exposure to only nitrate or atrazine in drinking water. This association does not imply causation but provides direction for further investigation.https://digitalcommons.unmc.edu/coph_pres/1011/thumbnail.jp

Colorectal Cancer Screening Uptake: Differences Between Rural and Urban Privately-Insured Population

Earlier studies investigated rural-urban colorectal cancer (CRC) screening disparities among older adults or used surveys. The objective was to compare screening uptake between rural and urban individuals 50-64 years of age using private health insurance. Data were analyzed from 58,774 Blue Cross Blue Shield of Nebraska beneficiaries. Logistic regression was used to assess the association between rural-urban and CRC screening use. Results indicate that rural individuals were 56% more likely to use the Fecal Occult Blood Test (FOBT) compared with urban residents, but rural females were 68% less likely to use FOBT. Individuals with few Primary Care Physician (PCP) visits and rural-women are the least to receive screening. To enhance CRC screening, a policy should be devised for the training and placement of female PCP in rural areas. In particular, multilevel interventions, including education, more resources, and policies to increase uptake of colorectal cancer screening, are needed. Further research is warranted to investigate barriers to CRC screening in rural areas

Cervical Cancer Screening among Patients Receiving ARVs in a Resource-Limited Environment

Significance Cervical cancer is the most common cancer worldwide with increased risk among women living with HIV in a resource limited environment. Hence the need to determine factors affecting awareness, prior uptake of cervical cancer screening and willingness to screen among patients receiving Antiretroviral (ARV) drugs. Data analysis The data was collected by administered questionnaires to patients presenting for monthly ARV refills in a HIV clinic in Dodoma, Tanzania. A total of 421 women in the clinic with an average monthly income of 39 (USD) were interviewed. A total of 306 (73%) were aware of cervical cancer. Among those who were aware, 84 % (257) did not recall been screened for cervical cancer. A total of 231 (90%) expressed willingness to be screened among patients who have never screened for cervical cancer. The average years since HIV infection for the subjects was 5.4 years; average age was 44. A logistic regression model was used to examine factors associated with awareness of cervical cancer, prior uptake of screening and willingness to be screened. Urban dwellers were found to have higher odds of awareness than rural dwellers (OR: 3.68 95% CI: 2.12-6.38). Prior uptake of screening was found higher among urban vs. rural dwellers, OR: 3.43, 95% CI: 1.02-11.51. The willingness to be screened decreased with age (OR: 0.93, 95% CI: 0.88-0.97). Conclusion This study have indicated the problem of access among rural dwellers to cervical cancer screening. Willingness to screen among younger patients could be due to increased awareness of the disease among younger patients than older patients. However, the older and rural patients are at higher risk of cervical cancer and should be targeted for primary prevention. Category Advocacy and Health Policyhttps://digitalcommons.unmc.edu/coph_pres/1007/thumbnail.jp

Effects of Partners Together in Health (PaTH) Intervention on Physical Activity and Healthy Eating Behaviors: A Pilot Study

Background—Despite proven efficacy of cardiac rehabilitation (CR) in helping patients initiate physical activity and healthy eating changes, less than 50% of CR participants maintain changes 6 months later. Objective—The objective of this feasibility study was to test the Partners Together in Health (PaTH) Intervention versus usual care (UC) in improving physical activity and healthy eating behaviors in coronary artery bypass graft (CABG) surgery patients and spouses. Methods—An experimental, two-group (n = 17 couples/group), repeated measures design was used. CABG patients in both groups participated in Phase II outpatient CR. Spouses in the PaTH group attended CR with the patient and were asked to make the same physical activity and healthy eating changes as patients. Spouses in the control group attended educational classes with patients. It was theorized that “two persons would be better than one” at making changes and sticking with them long-term. Physical activity behavior was measured using the Actiheart accelerometer; the activity biomarker was an exercise tolerance test. Eating behavior was measured using 3-day food records; the biomarker was the lipid profile. Data were collected at baseline (entrance in CR), 3-months (post-CR), and 6-months. Changes over time were examined using Mann-Whitney U statistics and effect sizes. Results—The PaTH intervention was successful primarily in demonstrating improved trends in healthy eating behavior for patients and spouses. No differences were found between the PaTH and UC patients or spouses at 3 or 6 months in the number of minutes/week of physical activity. By 6 months, patients in both groups were, on average, below the national guidelines for PA recommendations (≥ 150 min/week at \u3e 3 METs). Conclusions—The couple-focused PaTH intervention demonstrated promise in offsetting the decline in dietary adherence typically seen 6 months after CR

Effects of Partners Together in Health (PaTH) Intervention on Physical Activity and Healthy Eating Behaviors: A Pilot Study

Background—Despite proven efficacy of cardiac rehabilitation (CR) in helping patients initiate physical activity and healthy eating changes, less than 50% of CR participants maintain changes 6 months later. Objective—The objective of this feasibility study was to test the Partners Together in Health (PaTH) Intervention versus usual care (UC) in improving physical activity and healthy eating behaviors in coronary artery bypass graft (CABG) surgery patients and spouses. Methods—An experimental, two-group (n = 17 couples/group), repeated measures design was used. CABG patients in both groups participated in Phase II outpatient CR. Spouses in the PaTH group attended CR with the patient and were asked to make the same physical activity and healthy eating changes as patients. Spouses in the control group attended educational classes with patients. It was theorized that “two persons would be better than one” at making changes and sticking with them long-term. Physical activity behavior was measured using the Actiheart accelerometer; the activity biomarker was an exercise tolerance test. Eating behavior was measured using 3-day food records; the biomarker was the lipid profile. Data were collected at baseline (entrance in CR), 3-months (post-CR), and 6-months. Changes over time were examined using Mann-Whitney U statistics and effect sizes. Results—The PaTH intervention was successful primarily in demonstrating improved trends in healthy eating behavior for patients and spouses. No differences were found between the PaTH and UC patients or spouses at 3 or 6 months in the number of minutes/week of physical activity. By 6 months, patients in both groups were, on average, below the national guidelines for PA recommendations (≥ 150 min/week at \u3e 3 METs). Conclusions—The couple-focused PaTH intervention demonstrated promise in offsetting the decline in dietary adherence typically seen 6 months after CR

Human MUC4 mucin induces ultra-structural changes and tumorigenicity in pancreatic cancer cells.

MUC4 is a type-1 transmembrane glycoprotein and is overexpressed in many carcinomas. It is a heterodimeric protein of 930 kDa, composed of a mucin-type subunit, MUC4alpha, and a membrane-bound growth factor-like subunit, MUC4beta. MUC4 mRNA contains unique 5\u27 and 3\u27 coding sequences along with a large variable number of tandem repeat (VNTR) domain of 7-19 kb. A direct association of MUC4 overexpression has been established with the degree of invasiveness and poor prognosis of pancreatic cancer. To understand the precise role of MUC4 in pancreatic cancer, we engineered a MUC4 complementary DNA construct, mini-MUC4, whose deduced protein (320 kDa) is comparable with that of wild-type MUC4 (930 kDa) but represents only 10% of VNTR. Stable ectopic expression of mini-MUC4 in two human pancreatic cancer cell lines, Panc1 and MiaPaCa, showed that MUC4 minigene expression follows a biosynthesis and localisation pattern similar to the wild-type MUC4. Expression of MUC4 resulted in increased growth, motility, and invasiveness of the pancreatic cancer cells in vitro. Ultra-structural examination of MUC4-transfected cells showed the presence of increased number and size of mitochondria. The MUC4-expressing cells also demonstrated an enhanced tumorigenicity in an orthotopic xenograft nude mice model, further supporting a direct role of MUC4 in inducing the cancer properties. In conclusion, our results suggest that MUC4 promotes tumorigenicity and is directly involved in growth and survival of the cancer cells

Trans Collaborations Clinical Check-In (TC3): Initial Validation of a Clinical Measure for Transgender and Gender Diverse Adults Receiving Psychological Services

One key aspect of evidence-based psychological services is monitoring progress to inform treatment decision making, often using a brief self-report measure. However, no such measure exists to support measurement based care given the distinct needs of transgender and gender diverse people (TGD), a group facing large documented health disparities and marginalization in healthcare. The purpose of the present study was to develop and provide initial psychometric validation of a short, behavioral health progress monitoring self-report measure, the Trans Collaborations Clinical Check-in (TC3). TGD communities, providers identified as TGD-affirmative, and relevant academic experts contributed to item and scale development. The final 18 item version was administered to 215 TGD adults (75 transfeminine, 76 transmasculine, 46 nonbinary, 18 unknown; mean age of 30 with a range of 19 to 73), who were recruited for an online study, with other questionnaires assessing negative affect, well-being, gender dysphoria, gender minority stressors, and resilience. Higher scores on the TC3 (indicating better adjustment and comfort with gender) were generally associated with lower depression, anxiety, minority stress, and gender dysphoria and greater life satisfaction, body congruence, and positive aspects of being TGD such as pride in identity and community belongingness. These results support the validity of the TC3 as a brief measure to be used as a clinical tool for TGD people receiving mental health services. Additional research is needed on the reliability and validity of the TC3 across multiple time points to determine utility as a progress monitoring measure. The TC3 should also be further validated with more culturally diverse samples