ASSOCIATIONS BETWEEN HERPES SIMPLEX VIRUS TYPES 1 AND 2 (HSV-1 AND HSV-2), CYTOMEGALOVIRUS (CMV), EPSTEIN BARR VIRUS (EBV), HUMAN PAPILLOMA VIRUS (HPV), CHLAMYDIA TRACHOMATIS, NEISSERIA GONORRHOEAE INFECTIONS AND PREECLAMPSIA

BACKGROUND Atherosclerosis, endothelial dysfunction and inflammation are thought to be key pathophysiologic processes in preeclampsia. The basic thesis of this dissertation is that maternal infections may trigger upregulation of proinflammatory cytokines in women with preeclampsia resulting in vascular injury.OBJECTIVES We evaluated the evidence for a potential infectious disease etiology for preeclampsia in three papers. METHODS For the first paper, we conducted a 1:3 matched case control study. In this study we measured immunoglobulin G (IgG) antibodies to HSV-1, HSV-2, CMV, and EBV in serum samples obtained from 50 cases with preeclampsia and 150 normotensive controls, matched on age, parity and race. For the second paper, we conducted a comprehensive review of published studies that explored the association between both bacterial and viral infections, and examined the strength of this association. For the third paper, we investigated the association between self-reported Genital Warts (HPV), Genital Herpes (HSV-2), Chlamydia (C. trachomatis), Gonorrhea (N. gonorrhoeae) infections, sociodemographic, and behavioral risk factors and the risk of preeclampsia in a representative national sample of 10,847 reproductive age women.RESULTS We found that seroconversion for HSV 1 /2 or CMV was associated with a five-fold increased risk for developing preeclampsia (OR 5.4, 95% CI 1.0-29.0) after adjusting for education, income, smoking, years of cohabitation, medical insurance, and type of birth control. Pooling of relevant epidemiologic data, also revealed a two-fold increased risk of preeclampsia associated with bacterial and viral infections (OR 2.1, 95% CI 1.8-2.6). Additionally, population-based results suggest that Genital Warts, Genital Herpes, and C. trachomatis significantly increased the risk of preeclampsia (OR 3.0, 95% CI 1.0-8.8; OR 7.4, 95% CI 1.4-47.4; OR 5.2, 95% CI 1.3-20.2, respectively), after adjusting for socio-demographic, behavioral, and infection-related risk factors. PUBLIC HEALTH RELEVANCE Given the widespread prevalence of these infections, and the potential to prevent infection, our findings have important public health implications in the context of potential preventive strategies and identification of high-risk individuals

Adherence to diabetes self-care behaviors in English- and Spanish-speaking Hispanic men

We conducted a qualitative study to elicit attitudes, attributions, and self-efficacy related to diabetes self-care in both English- and Spanish-speaking Hispanic men. Transcripts from six focus groups (three in English and three in Spanish) were reviewed by the authors to extract principal and secondary themes. Participants could describe their medication and lifestyle regimens and were aware of whether they were adherent or nonadherent to physician recommendations. Lack of skills on how to incorporate diet and regular physical activity into daily living, lack of will power, and reluctance to change culturally rooted behaviors emerged as significant barriers to diabetes self-management. Medication adherence is for some men the principal diabetes self-care behavior. Nonadherence appeared to fit two profiles: 1) intentional, and 2) nonintentional. In both instances low self-efficacy emerged as a significant influence on attainment and maintenance of diabetes self-care goals. Participants also expressed a strong sense of fatalism regarding the course of their disease, and seemed to have little motivation to attempt long-term dietary control. Educational and counseling messages should stress that a diagnosis of diabetes is not a death sentence, and full functional capacity can be maintained with good control

Association between Water Fluoride Levels and Low Birth Weight: National Health and Nutrition Examination Survey (NHANES) 2013–2016

Background: Excessive fluoride consumption affects reproductive and child health. We examined the association between levels of fluoride in drinking water and birth weight, in the National Health and Nutrition Examination Survey 2013–2016, after adjusting for known risk factors Low Birth Weight (LBW) including age, smoking, and socio-demographic variables including education, food security, health care access, and health status. Methods: The study included 7147 and 6858 women with complete birth weight and water fluoride data, respectively. Linear regression models evaluated the association between water fluoride and birth weight across racial/ethnic groups. The odds of delivering an LBW infant (<2500 g) compared to an infant weighing ≥ 2500 g, as well as the odds of delivering a Very Low Birth Weight (VLBW, <1500 g) infant compared to an LBW infant were explored in separate logistic regression models. Results: Women with LBW infants were exposed to significantly higher levels of water fluoride compared to those with normal birth weight infants. Our findings suggest a significant association between excess water fluoride exposure (>0.7 ppm) and LBW weight in Hispanic women, independent of established LBW risk factors. In logistic regression models, Hispanic women exposed to increased levels of water fluoride were 1.5 times more likely to give birth to an LBW infant and 3.5 more likely to give birth to a VLBW infant. Conclusion: Taken together, these findings can inform public health education strategies that highlight water fluoride as a potential risk factor during pregnancy in Hispanic women. More research is needed to confirm these findings