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Ozone effects on blood biomarkers of systemic inflammation, oxidative stress, endothelial function, and thrombosis: The Multicenter Ozone Study in oldEr Subjects (MOSES).
The evidence that exposure to ozone air pollution causes acute cardiovascular effects is mixed. We postulated that exposure to ambient levels of ozone would increase blood markers of systemic inflammation, prothrombotic state, oxidative stress, and vascular dysfunction in healthy older subjects, and that absence of the glutathione S-transferase Mu 1 (GSTM1) gene would confer increased susceptibility. This double-blind, randomized, crossover study of 87 healthy volunteers 55-70 years of age was conducted at three sites using a common protocol. Subjects were exposed for 3 h in random order to 0 parts per billion (ppb) (filtered air), 70 ppb, and 120 ppb ozone, alternating 15 min of moderate exercise and rest. Blood was obtained the day before, approximately 4 h after, and approximately 22 h after each exposure. Linear mixed effect and logistic regression models evaluated the impact of exposure to ozone on pre-specified primary and secondary outcomes. The definition of statistical significance was p<0.01. There were no effects of ozone on the three primary markers of systemic inflammation and a prothrombotic state: C-reactive protein, monocyte-platelet conjugates, and microparticle-associated tissue factor activity. However, among the secondary endpoints, endothelin-1, a potent vasoconstrictor, increased from pre- to post-exposure with ozone concentration (120 vs 0 ppb: 0.07 pg/mL, 95% confidence interval [CI] 0.01, 0.14; 70 vs 0 ppb: -0.03 pg/mL, CI -0.09, 0.04; p = 0.008). Nitrotyrosine, a marker of oxidative and nitrosative stress, decreased with increasing ozone concentrations, with marginal significance (120 vs 0 ppb: -41.5, CI -70.1, -12.8; 70 vs 0 ppb: -14.2, CI -42.7, 14.2; p = 0.017). GSTM1 status did not modify the effect of ozone exposure on any of the outcomes. These findings from healthy older adults fail to identify any mechanistic basis for the epidemiologically described cardiovascular effects of exposure to ozone. The findings, however, may not be applicable to adults with cardiovascular disease
Attitudes and behaviors among older MSM in Ghana
This study was implemented by Boston University in collaboration with the Kwame Nkrumah University of Science and Technology with support from the Presidentâs Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development under Project SEARCH Task Order No. GHHâIâ00â07â00023â00, beginning August 27, 2010. The content and views expressed here are the authorsâ and do not necessarily reflect the opinion or policy of USAID or the U.S. Government.This report provides the findings of a qualitative study that explored vulnerability to HIV of men who have sex with men (MSM) in Kumasi, Ghana. It is the second of two related studies focusing on MSM. The first study, âExploring the beliefs, attitudes, and behaviors of MSM engaged in substance use and transactional sex in Ghana,â1 focused on adolescent and young adult MSM aged 15 to 29 years. This companion study focused on âolder MSMâ, encompassing individuals aged 30 years and above. This research was conducted by a collaborative team comprised of researchers from Boston Universityâs Center for Global and Health and Development (CGHD) and the Kwame Nkrumah University of Science and Technology (KNUST). The team conducted this research in Kumasi, Ghanaâs second largest urban center. It is a component of the âOperations Research for Key Populations in Ghanaâ Program funded by the United States Agency for International Development (USAID). We designed and carried out the study in collaboration with FHI 360, an organization based in the capital of Accra that operates programs targeting MSM and other highârisk individuals in Ghana, as well as the Ghana AIDS Commission (GAC). Reducing vulnerability to HIV infection among highârisk populations in Ghana is a major goal for the National AIDS Control Program (NACP) and the GAC. MSM are highly stigmatized in Ghana, in part because maleâtoâmale sex is illegal. This makes it extremely challenging to understand the challenges these men face and ensure that they have access to HIVâ and AIDSârelated services. We designed this qualitative study to add to what is known about the beliefs, attitudes, and behaviors of older MSM in Ghana. We focused on two groups among older MSM: those aged 30â39 years and those aged 40 years and above. Given the need for more data on these groups to better reach them with effective HIV prevention and treatment information, the study aimed to explore: 1) How older MSM find their sex partners; 2) Their views of HIV risk; 3) Their risky behaviors, including those situations in which they are most likely to engage in risky sex; 4) HIVârelated services they receive; and 5) What services would be most helpful to them. The broad goal of the study was to collect and analyze inâdepth data in order to improve the outreach and effectiveness of local programs that aim to reach older MSM with important HIV prevention and treatment information and with services appropriate to their needs.Support from the Presidentâs Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development under Project SEARCH Task Order No. GHHâIâ00â07â00023â00, beginning August 27, 201
Health-related quality of life in children and young adults with Marfan syndrome
Objective: To assess health-related quality of life (HRQOL) in a large multicenter cohort of children and young adults with Marfan syndrome participating in the Pediatric Heart Network Marfan Trial.
Study design: The Pediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core Scales were administered to 321 subjects with Marfan syndrome (5-25 years). PedsQL scores were compared with healthy population norms. The impact of treatment arm (atenolol vs losartan), severity of clinical features, and number of patient-reported symptoms on HRQOL was assessed by general linear models.
Results: Mean PedsQL scores in children (5-18 years) with Marfan syndrome were lower than healthy population norms for physical (P <= .003) and psychosocial (P < .001) domains; mean psychosocial scores for adults (19-25 years) were greater than healthy norms (P < .001). HRQOL across multiple domains correlated inversely with frequency of patient-reported symptoms (r = 0.30-0.38, P < .0001). Those <18 years of age with neurodevelopmental disorders (mainly learning disability, attention-deficit/hyperactivity disorder) had lower mean PedsQL scores (5.5-7.4 lower, P < .04). A multivariable model found age, sex, patient-reported symptoms, and neurodevelopmental disorder to be independent predictors of HRQOL. There were no differences in HRQOL scores by treatment arm, aortic root z score, number of skeletal features. or presence of ectopia lentis.
Conclusions: Children and adolescents with Marian syndrome were at high risk for impaired HRQOL. Patient-reported symptoms and neurodevelopmental disorder. but not treatment arm or severity of Marian syndrome-related physical findings, were associated with lower HRQOL