Congenital infections as contributors to the onset of diabetes in children: A longitudinal study in the United States, 2001‐2017

BackgroundMaternal infections during pregnancy, particularly with rubella virus, were reported to increase the risk of diabetes in children. Widespread vaccination has decreased the number of infants with congenital rubella syndrome in the United States, although it remains a problem in developing countries. Because vaccine hesitancy has recently increased, we investigated the association between congenital infections with subsequent diabetes risk in children in the United States.MethodsUsing data from a nationwide private health insurer for years 2001‐2017, 1 475 587 infants were followed for an average of 3.9 years (maximum 16.5 years). Information was obtained regarding congenital infections (rubella, cytomegalovirus, other congenital infections) and perinatal infections, as well as for the development of diabetes mellitus and diabetic ketoacidosis.ResultsThere were 781 infants with congenital infections and 73 974 with perinatal infections. Diabetes developed in 3334 children. The odds of developing diabetes for infants with congenital rubella infection were 12‐fold greater (P = .013) and, for infants with congenital cytomegalovirus infection, were 4‐fold greater (P = .011) than infants without congenital or perinatal infection. Infants with other congenital infections had 3‐fold greater odds of developing diabetes (P = .044). Results were similar for diabetes ketoacidosis. Infants with other perinatal infections had 49% greater odds of developing diabetes during the follow‐up period (P < .001).ConclusionCongenital and other perinatal infections are associated with elevated risks of developing diabetes mellitus during childhood. Vaccination for rubella remains an important preventive action to reduce the incidence of diabetes in children.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154971/1/pedi12957.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154971/2/pedi12957_am.pd

Resonances and superlattice pattern stabilization in two-frequency forced Faraday waves

We investigate the role weakly damped modes play in the selection of Faraday wave patterns forced with rationally-related frequency components m*omega and n*omega. We use symmetry considerations to argue for the special importance of the weakly damped modes oscillating with twice the frequency of the critical mode, and those oscillating primarily with the "difference frequency" |n-m|*omega and the "sum frequency" (n+m)*omega. We then perform a weakly nonlinear analysis using equations of Zhang and Vinals (1997, J. Fluid Mech. 336) which apply to small-amplitude waves on weakly inviscid, semi-infinite fluid layers. For weak damping and forcing and one-dimensional waves, we perform a perturbation expansion through fourth order which yields analytical expressions for onset parameters and the cubic bifurcation coefficient that determines wave amplitude as a function of forcing near onset. For stronger damping and forcing we numerically compute these same parameters, as well as the cubic cross-coupling coefficient for competing waves travelling at an angle theta relative to each other. The resonance effects predicted by symmetry are borne out in the perturbation results for one spatial dimension, and are supported by the numerical results in two dimensions. The difference frequency resonance plays a key role in stabilizing superlattice patterns of the SL-I type observed by Kudrolli, Pier and Gollub (1998, Physica D 123).Comment: 41 pages, 13 figures; corrected figure 1b and minor typos in tex

Increased Risk of Infection and Mortality in Women after Cardiac Surgery Related to Allogeneic Blood Transfusion

Background: Infection and mortality rates are greater in women than in men after cardiac surgery. This study was conducted to assess whether allogeneic blood transfusion could partially account for this gender difference, as transfusion has been associated with immunomodulation. Methods: A cohort study was conducted in 380 patients at the University of Rochester Medical Center. Subjects were adult patients who underwent primary coronary artery bypass graft (CABG) surgery, primary valve replacement surgery, or both. Information was collected about blood components transfused, as well as postoperative infection, pulmonary dysfunction, and in-hospital mortality. Results: Women were more likely to receive allogeneic red blood cells (RBCs) or platelets than men (odds ratio [OR] 21.6, 95% CI 3.8, 124.2) and a greater quantity of blood than men. Patients who received allogeneic blood were 4.4 times more likely to develop an infection than those who did not (95% CI 1.5, 13.2). There was a positive linear correlation between number of units of blood received and number of days with fever (p < 0.001) and hospital length of stay (p < 0.001). This was particularly evident in patients who received four or more units of nonleukoreduced blood components. Women had a greater risk of infection (p = 0.005), pulmonary dysfunction (p = 0.005), and mortality (p = 0.007) than men during hospitalization. Conclusions: One reason for the greater mortality in women after cardiac surgery may be the increased likelihood of receiving nonleukoreduced allogeneic RBCs and platelets. Transfusion increased the risk of infection; infection, then, increased the likelihood of pulmonary dysfunction and mortality.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63383/1/jwh.2007.0397.pd

Meta-analysis: insulin sensitizers for the treatment of non-alcoholic steatohepatitis

Aliment Pharmacol Ther 2010; 32: 1211–1221Non-alcoholic fatty liver disease generally has a benign course; however, patients with non-alcoholic steatohepatitis (NASH) may progress to cirrhosis and hepatocellular carcinoma. Currently, there is a lack of consensus about optimal NASH treatment.To assess the efficacy of insulin-sensitizing agents on histological and biochemical outcomes in randomized control trials of biopsy-proven NASH.Multiple online databases and conference abstracts were searched. Random effects meta-analyses were performed, with assessment for heterogeneity and publication bias.Nine trials were included; five trials using thiazolidinediones (glitazones), three using metformin and one trial using both drugs. There was no publication bias. Compared with controls, glitazones resulted in improved steatosis (WMD = 0.57, 95% CI 0.36–0.77, P  = <0.001), hepatocyte ballooning (WMD = 0.36, 95% CI 0.24–0.49, P  < 0.001) and ALT (WMD = 16.4, 95% CI 7.7–25.0, P  < 0.001), but not inflammation ( P  = 0.09) or fibrosis ( P  = 0.11). In patients without diabetes, glitazones significantly improved all histological and biochemical outcomes, most importantly including fibrosis (WMD = 0.29, 95% CI 0.078–0.51, P  = 0.008). Metformin failed to improve any pooled outcome.Treatment of NASH with glitazones, but not metformin, demonstrates a significant histological and biochemical benefit, especially in patients without diabetes. Additional studies are needed to investigate long-term outcomes of glitazone therapy in patients without diabetes.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79251/1/j.1365-2036.2010.04467.x.pd

Microbiota-based model improves the sensitivity of fecal immunochemical test for detecting colonic lesions

Abstract Background Colorectal cancer (CRC) is the second leading cause of death among cancers in the United States. Although individuals diagnosed early have a greater than 90 % chance of survival, more than one-third of individuals do not adhere to screening recommendations partly because the standard diagnostics, colonoscopy and sigmoidoscopy, are expensive and invasive. Thus, there is a great need to improve the sensitivity of non-invasive tests to detect early stage cancers and adenomas. Numerous studies have identified shifts in the composition of the gut microbiota associated with the progression of CRC, suggesting that the gut microbiota may represent a reservoir of biomarkers that would complement existing non-invasive methods such as the widely used fecal immunochemical test (FIT). Methods We sequenced the 16S rRNA genes from the stool samples of 490 patients. We used the relative abundances of the bacterial populations within each sample to develop a random forest classification model that detects colonic lesions using the relative abundance of gut microbiota and the concentration of hemoglobin in stool. Results The microbiota-based random forest model detected 91.7 % of cancers and 45.5 % of adenomas while FIT alone detected 75.0 % and 15.7 %, respectively. Of the colonic lesions missed by FIT, the model detected 70.0 % of cancers and 37.7 % of adenomas. We confirmed known associations of Porphyromonas assaccharolytica, Peptostreptococcus stomatis, Parvimonas micra, and Fusobacterium nucleatum with CRC. Yet, we found that the loss of potentially beneficial organisms, such as members of the Lachnospiraceae, was more predictive for identifying patients with adenomas when used in combination with FIT. Conclusions These findings demonstrate the potential for microbiota analysis to complement existing screening methods to improve detection of colonic lesions.http://deepblue.lib.umich.edu/bitstream/2027.42/134551/1/13073_2016_Article_290.pd

Aquatic Exercise for Better Living on Land: Impact of Shallow-Water Exercise on Older Japanese Women for Performance of Activities of Daily Living (ADL)

Twenty-six Japanese women (70.5 yr) self-selected water exercise (WEX) (n=13), or control (CON) (n=13) for 12 weeks. WEX was performed 60-minutes/day, 3 days/week with warm-up, cool-down stretch, ADL exercises, and cardiovascular/muscular endurance in 30°C water at a xiphoid level depth. CON continued their current activity/nutrition patterns. Compared to CON, WEX improved (p\u3c.05) functional fitness and balance measures including arm curl (22%), chair stand (21%), 8-feet up & go (13%), chair sit/reach (50%), and 12-min walk (15%). No significant changes in sway velocity (SV) or limits of stability (LOS) were seen for either group. This shallow water exercise improved land-based ADL for older women but not balance. ADL tasks associated with balance did improve which may have indicated enhanced motor control

Translating research into MCH service: comparison of a pilot project and a large-scale resource mothers program.

This study examines the process and effect of translating a pilot research project into a large-scale service program. In a pilot resource mothers program for pregnant teenagers, participants had fewer low birth weight infants than teenagers in the comparison group. In the corresponding large-scale service program, a similarly positive effect on low birth weight was not seen. In an effort to understand how these differences occurred, the evaluation methodologies and key characteristics that describe the background, infrastructure, components, and service providers of the two projects were compared. Important differences between the pilot project and the service program were seen in funding stability, diversity of staff, community versus health department ownership of the program, caseloads, and levels of training and supervision. It seems probable that these differences brought about changes in the intensity and character of the intervention from the pilot to the service program, leading to a reduction of the intervention's efficacy in reducing the number of low birth weight infants. The implications of these findings for researchers and program planners are discussed

DNA from fecal immunochemical test can replace stool for detection of colonic lesions using a microbiota-based model

Abstract Background There is a significant demand for colorectal cancer (CRC) screening methods that are noninvasive, inexpensive, and capable of accurately detecting early stage tumors. It has been shown that models based on the gut microbiota can complement the fecal occult blood test and fecal immunochemical test (FIT). However, a barrier to microbiota-based screening is the need to collect and store a patient’s stool sample. Results Using stool samples collected from 404 patients, we tested whether the residual buffer containing resuspended feces in FIT cartridges could be used in place of intact stool samples. We found that the bacterial DNA isolated from FIT cartridges largely recapitulated the community structure and membership of patients’ stool microbiota and that the abundance of bacteria associated with CRC were conserved. We also found that models for detecting CRC that were generated using bacterial abundances from FIT cartridges were equally predictive as models generated using bacterial abundances from stool. Conclusions These findings demonstrate the potential for using residual buffer from FIT cartridges in place of stool for microbiota-based screening for CRC. This may reduce the need to collect and process separate stool samples and may facilitate combining FIT and microbiota-based biomarkers into a single test. Additionally, FIT cartridges could constitute a novel data source for studying the role of the microbiome in cancer and other diseases.http://deepblue.lib.umich.edu/bitstream/2027.42/134673/1/40168_2016_Article_205.pd

Depression, antidepressant medications, and risk of Clostridium difficile infection

Abstract Background An ancillary finding in previous research has suggested that the use of antidepressant medications increases the risk of developing Clostridium difficile infection (CDI). Our objective was to evaluate whether depression or the use of anti-depressants altered the risk of developing CDI, using two distinct datasets and study designs. Methods In Study 1, we conducted a longitudinal investigation of a nationally representative sample of older Americans (n = 16,781), linking data from biennial interviews to physician and emergency department visits, stays in hospital and skilled nursing facilities, home health visits, and other outpatient visits. In Study 2, we completed a clinical investigation of hospitalized adults who were tested for C. difficile (n = 4047), with cases testing positive and controls testing negative. Antidepressant medication use prior to testing was ascertained. Results The population-based rate of CDI in older Americans was 282.9/100,000 person-years (95% confidence interval (CI)) 226.3 to 339.5) for individuals with depression and 197.1/100,000 person-years for those without depression (95% CI 168.0 to 226.1). The odds of CDI were 36% greater in persons with major depression (95% CI 1.06 to 1.74), 35% greater in individuals with depressive disorders (95% CI 1.05 to 1.73), 54% greater in those who were widowed (95% CI 1.21 to 1.95), and 25% lower in adults who did not live alone (95% CI 0.62 to 0.92). Self-reports of feeling sad or having emotional, nervous or psychiatric problems at baseline were also associated with the later development of CDI. Use of certain antidepressant medications during hospitalization was associated with altered risk of CDI. Conclusions Adults with depression and who take specific anti-depressants seem to be more likely to develop CDI. Older adults who are widowed or who live alone are also at greater risk of CDI.http://deepblue.lib.umich.edu/bitstream/2027.42/112859/1/12916_2012_Article_763.pd

Under Pressure: Financial Effect of the Hospital‐Acquired Conditions Initiative–A Statewide Analysis of Pressure Ulcer Development and Payment

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/112254/1/jgs13475.pd