The Use of Vital Statistics Data for Research of Consequence: Birth Outcomes and Population Health in a Rural Region

Objective: The Affordable Care Act (ACA) has influenced increasing interests in population health and population health outcomes. The purpose of this study was to exemplify the importance of using existing vital statistics data for understanding and monitoring health outcomes and consequentially health disparities at the population level. Data from birth records for two geographic regions from 2009-2014 were compared; low birth weight (LBW) and preterm delivery (PD) were used as surrogates for population health outcomes. Methods: A population-based, multi-year, cross-sectional study design using a pooled dataset of birth records from Tennessee (TN) was the framework for the analyses. A sub-population from North East TN (NE TN) was compared to TN. Logistic regression was used to estimate odds ratios. Attributable risks were calculated to translate the findings from conditional associations to population-level associations to help inform public health policy decision-making. Results: Using birth records (vital statistics), we demonstrated that the period prevalence of cigarette smoking before and during pregnancy remained unchanged with approximately one in three women in NE TN (from 37% in 2009 to 32% in 2014) and one in five women in TN (from 23% in 2009 to 20% in 2014) reporting smoking pre-pregnancy. Multivariate analyses demonstrated that mothers who were at each end of the age spectrum, of very low household income level and reported cigarette smoking pre-pregnancy or during pregnancy had increased risk of a LBW or PD infant. During the years of observation, 39 to 50% of the total incidence of LBW in the group of women who smoked cigarettes prior to pregnancy was attributable to smoking cigarettes. Conclusions: Existing data, such as vital statistics data, should be used routinely to identify geographic areas for which programs or policies can be implemented to reach large portions of populations. Reducing prenatal smoking, for example, has the potential to reduce a large fraction of adverse birth outcomes such as LBW and PD. For the geographic area we evaluated, 39 to 50% of LBW could be prevented by devising population-based smoking cessation programs or policies for women of child-bearing age. With recent emphasis on prevention and well-baby care in the ACA, there is potential to increase attention to this problem, implement evidence-based prevention programs and monitor program effectiveness with existing birth record data. Following this model, we can attain population health goals and address health disparities

Project Passport: An Integrated Group-Centered Approach Targeting Pregnant Teens and Their Partners

Objective: To describes the development of Project Passport, a perinatal intervention designed to reduce negative outcomes among pregnant teens. Methods: A logic model guided the planning, development and evaluation plan for the intervention. It included the selection of health goals, behaviors to be targeted, determinants of the selected behaviors, and activities to impact each selected determinant. Results: The process resulted in the formulation of an intervention that incorporates CenteringPregnancy, a group model of prenatal care, Positive Youth Development components, and male involvement. The evaluation examines the effectiveness of the intervention in enhancing health, educational and psychosocial outcomes among pregnant adolescents. Conclusions: The present program was designed to address an important gap in evidence-based interventions targeting pregnant adolescents and their partners

High Prevalence of Hepatitis B Virus Markers in Romanian Adolescents With Human Immunodeficiency Virus Infection

<p>Abstract</p> <p>Background</p> <p>We evaluated the frequency of hepatitis coinfection in Romanian adolescents who were diagnosed with human immunodeficiency virus (HIV) infection prior to 1995.</p> <p>Methods</p> <p>One hundred sixty-one adolescents (13–18 years of age) with symptomatic HIV infection, but without signs of hepatic dysfunction, and 356 age-matched, HIV-uninfected controls underwent laboratory testing for markers of parenterally acquired hepatitis virus infection.</p> <p>Results</p> <p>Seventy-eight percent of HIV-infected adolescents had markers of past or present hepatitis B virus (HBV) infection, as compared with 32% of controls (<it>P </it>= .0001). The prevalence of HBV replicative markers was more than 5-fold higher in HIV-infected adolescents as compared with controls: 43.4% vs 7.9% (<it>P </it>= .0001), respectively, for hepatitis B surface antigen (HBsAg); and 11.2% vs 2.2% (<it>P </it>= .0001), respectively, for hepatitis B e antigen (HBeAg). The prevalence of HBsAg chronic carriers and the presence of HBV replicative markers was significantly higher in patients with immunologically defined AIDS (CD4+ cell counts < 200 cells/mcL): 59.6% vs 34.6% (<it>P </it>= .02) for HBsAg and 22.8% vs 5.7%, (<it>P </it>= .002) for HBV DNA. After 1 year of follow-up, the proportion of those who cleared the HBeAg was considerably lower in severely immunosuppressed coinfected patients: 4.7% vs 37.1% (<it>P </it>= .003). Four additional HIV-infected adolescents became HBsAg-positive over the term of follow-up (incidence rate, 24.9/1000 person-years), despite a record of immunization against hepatitis B.</p> <p>Conclusion</p> <p>A substantial percentage of HIV-infected and HIV-uninfected Romanian adolescents have evidence of past or present HBV infection. In HIV-infected adolescents, the degree of immunosuppression is correlated with persistence of HBV replicative markers, even in the absence of clinical or biochemical signs of liver disease.</p

High Prevalence of Hepatitis B Virus Markers in Romanian Adolescents With Human Immunodeficiency Virus Infection

<p>Abstract</p> <p>Background</p> <p>We evaluated the frequency of hepatitis coinfection in Romanian adolescents who were diagnosed with human immunodeficiency virus (HIV) infection prior to 1995.</p> <p>Methods</p> <p>One hundred sixty-one adolescents (13–18 years of age) with symptomatic HIV infection, but without signs of hepatic dysfunction, and 356 age-matched, HIV-uninfected controls underwent laboratory testing for markers of parenterally acquired hepatitis virus infection.</p> <p>Results</p> <p>Seventy-eight percent of HIV-infected adolescents had markers of past or present hepatitis B virus (HBV) infection, as compared with 32% of controls (<it>P </it>= .0001). The prevalence of HBV replicative markers was more than 5-fold higher in HIV-infected adolescents as compared with controls: 43.4% vs 7.9% (<it>P </it>= .0001), respectively, for hepatitis B surface antigen (HBsAg); and 11.2% vs 2.2% (<it>P </it>= .0001), respectively, for hepatitis B e antigen (HBeAg). The prevalence of HBsAg chronic carriers and the presence of HBV replicative markers was significantly higher in patients with immunologically defined AIDS (CD4+ cell counts < 200 cells/mcL): 59.6% vs 34.6% (<it>P </it>= .02) for HBsAg and 22.8% vs 5.7%, (<it>P </it>= .002) for HBV DNA. After 1 year of follow-up, the proportion of those who cleared the HBeAg was considerably lower in severely immunosuppressed coinfected patients: 4.7% vs 37.1% (<it>P </it>= .003). Four additional HIV-infected adolescents became HBsAg-positive over the term of follow-up (incidence rate, 24.9/1000 person-years), despite a record of immunization against hepatitis B.</p> <p>Conclusion</p> <p>A substantial percentage of HIV-infected and HIV-uninfected Romanian adolescents have evidence of past or present HBV infection. In HIV-infected adolescents, the degree of immunosuppression is correlated with persistence of HBV replicative markers, even in the absence of clinical or biochemical signs of liver disease.</p

Production of Interferons and β-Chemokines by Placental Trophoblasts of HIV-1-Infected Women

Objective: The mechanism whereby the placental cells of a human immunodeficiency virus (HIV)-1-infected mother protect the fetus from HIV-1 infection is unclear. Interferons (IFNs) inhibit the replication of viruses by acting at various stages of the life cycle and may play a role in protecting against vertical transmission of HIV-1. In addition the β-chemokines RANTES (regulated on activation T cell expressed and secreted), macrophage inflammatory protein-1-α (MIP-1α), and MIP-1β can block HIV-1 entry into cells by preventing the binding of the macrophage-trophic HIV-1 strains to the coreceptorCCR5. In this study the production of IFNs and β-chemokines by placental trophoblasts of HIV-1-infected women who were HIV-1 non-transmitters was examined. Methods: Placental trophoblastic cells were isolated from 29 HIV-1-infected and 10 control subjects. Supernatants of trophoblast cultures were tested for the production of IFNs and β-chemokines by enzyme linked immunosorbent assay (ELISA). Additionally, HIV-1-gag and IFN-β transcripts were determined by a semi-quantitative reverse transcription polymerase chain reaction (RT-PCR) assay. Results: All placental trophoblasts of HIV-1-infected women contained HIV-1-gag transcripts. There were no statistical differences in the median constitutive levels of IFN-α and IFN-γ produced by trophoblasts of HIV-1- infected and control subjects. In contrast, trophoblasts of HIV-1-infected women constitutively produced significantly higher levels of IFN-β protein than trophoblasts of control subjects. Furthermore, the median levels of β-chemokines produced by trophoblasts of HIV-infected and control women were similar. Conclusions: Since there was no correlation between the placental HIV load and the production of interferons or β-chemokines, the role of trophoblast-derived IFNs and β-chemokines in protecting the fetus from infection with HIV-1 is not clear

The first application of sensory structures based on photoelectric transducer for the study of enzymatic reactions

Background. The development of highly sensitive sensor equipment with the possibility of registering analytes in real time is a fast growing research area and a promising diagnostic biomedical technology. Currently, the standard laboratory method for determining the activities of ATPses is an indirect spectroscopic study of the concentration of inorganic phosphate formed as a result of ATP hydrolysis by these enzymes. However, there is no commercially available phosphate sensor with satisfactory parameters of sensitivity, selectivity and stability over time. The purpose of our research was the deve­lopment of a photoelectric recombination sensor system for the real-time detection of biochemical markers and its testing on the example of screening ATPase activity of rat erythrocyte plasma membrane suspension preparations. Materials and Methods. Experiments were performed on suspension preparations of plasma membranes of erythrocytes of Wistar rats. Preparations of plasma membrane suspensions obtained by Dodge method from each animal were divided into aliquots and used for the simultaneous study of ATPase activity by the reference method of Rathbun & Betlach, as well as the registration of photocurrents induced during the passage of the ATPase reaction using the photoelectric recombination multisensor system of our own design. Results. The application of silicon sensory structures based on photoelectrical transducer principle for detecting the activity of adenosine triphosphate hydrolases on the example of total Mg2+,Na+,K+-ATPases preparations of plasma membranes of rat erythro­cytes has been experimentally tested. The directly measured analytic parameter is the photocurrent of the deep silicon barrier structure under illumination with high absorption coefficient. The physical features of the device operation have been examined. Detection of such metabolites becomes possible due to reactions intermediates with their own dipole moment (inorganic phosphate, which is one of the products of ATP hydrolysis). The drastic change of photocurrent that characterizes the course of biochemical reaction was observed in real time. The effect is explained by local electrostatic influence on the parameters of recombination centers at the silicon surface that results in surface recombination velocity change. The sensor operation is qualitatively explained in the frame of Stevenson-Keyes’s theory. Conclusions. Our approach can be regarded as a promising way to elaborate technically simple and highly sensitive method for detection of quantitative behavior of enzymatic reactions. Moreover, the local modification of silicon surface allows obtaining time depending scenarios of the adsorption and thus improving the sensitivity of the sensor. These circumstances open up the possibility of elaborating the complex sensory structures with optimized parameters for certain enzymatic reactions

Human adipose tissue as a reservoir for memory CD4\u3csup\u3e+\u3c/sup\u3e T cells and HIV

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. Objective: The objective of this study is to determine whether adipose tissue functions as a reservoir for HIV-1. Design: We examined memory CD4+ T cells and HIV DNA in adipose tissue-stromal vascular fraction (AT-SVF) of five patients [four antiretroviral therapy (ART)-treated and one untreated]. To determine whether adipocytes stimulate CD4+ T cells and regulate HIV production, primary human adipose cells were cocultured with HIV-infected CD4+ T cells. Methods: AT-SVF T cells were studied by flow cytometry, and AT-SVF HIV DNA (Gag and Env) was examined by nested PCR and sequence analyses. CD4+ T-cell activation and HIV production were measured by flow cytometry and ELISA. Results: AT-SVF CD3+ T cells were activated (\u3e60% CD69+) memory CD4+ and CD8+ T cells in uninfected andHIV-infected persons, but the AT-SVF CD4+/CD8+ ratiowas lower in HIV patients. HIVDNA(Gag and Env)was detected in AT-SVF of all five patients examined by nested PCR, comparably to other tissues [peripheral blood mononuclear cell (PBMC), lymph node or thymus]. In coculture experiments, adipocytes increased CD4+ T-cell activation and HIV production approximately two to three-fold in synergy with gammachain cytokines interleukin (IL)-2, IL7 or IL15. These effects were mitigated by neutralizing antibodies against IL6 and integrin-a1b1. Adipocytes also enhanced T-cell viability. Conclusion: Adipose tissues of ART-treated patients harbour activated memory CD4+ T cells and HIV DNA. Adipocytes promote CD4+ T-cell activation and HIV production in concert with intrinsic adipose factors. Adipose tissue may be an important reservoir for HIV