Does Chlamydia pneumoniae Infection Trigger to Development of Asthma in Wheezy Infants?

The role of Chlamydia pneumonia (CP) infection in infantile asthma remains obscure. CP infection was serologically determined (Immunoglobulin M antibody titer of index (ID) ≥ 2.00) in wheezing infants who were then re-examined at 3 years of age to determine whether asthma is associated with CP infection. Wheezing infants with CP infection progressed to asthma more frequently than those who were not infected. These findings may suggest that CP infection triggers the development of asthma in wheezy infants.     

Are Neighborhood-Level Characteristics Associated with Indoor Allergens in the Household?

Background: Individual home characteristics have been associated with indoor allergen exposure; however, the influence of neighborhood-level characteristics has not been well studied. We defined neighborhoods as community districts determined by the New York City Department of City Planning. Objective: We examined the relationship between neighborhood-level characteristics and the presence of dust mite (Der f 1), cat (Fel d 1), cockroach (Bla g 2), and mouse (MUP) allergens in the household. Methods: Using data from the Puerto Rican Asthma Project, a birth cohort of Puerto Rican children at risk of allergic sensitization (n = 261), we examined associations between neighborhood characteristics (percent tree canopy, asthma hospitalizations per 1,000 children, roadway length within 100 meters of buildings, serious housing code violations per 1000 rental units, poverty rates, and felony crime rates), and the presence of indoor allergens. Allergen cutpoints were used for categorical analyses and defined as follows: dust mite: >0.25 μg/g; cat: >1 μg/g; cockroach: >1 U/g; mouse: >1.6 μg/g. Results: Serious housing code violations were statistically significantly positively associated with dust mite, cat, and mouse allergens (continuous variables), adjusting for mother's income and education, and all neighborhood-level characteristics. In multivariable logistic regression analyses, medium levels of housing code violations were associated with higher dust mite and cat allergens (1.81, 95%CI: 1.08, 3.03 and 3.10, 95%CI: 1.22, 7.92, respectively). A high level of serious housing code violations was associated with higher mouse allergen (2.04, 95%CI: 1.15, 3.62). A medium level of housing code violations was associated with higher cockroach allergen (3.30, 95%CI: 1.11, 9.78). Conclusions: Neighborhood-level characteristics, specifically housing code violations, appear to be related to indoor allergens, which may have implications for future research explorations and policy decisions.     

Celiac Disease: Does Hyposplenism Predispose to the Development of Malignant Disease?

Splenic size and function was assessed in eight patients with celiac disease and coexisting malignancy (six had small bowel lymphoma and two gastric adenocarcinoma). The size of the spleen was reduced in four of seven patients as seen at autopsy or radionucleotide scanning. Splenic function was studied using "pitted" erythrocyte counts, platelet counts, and Howell-Jolly bodies and was impaired in five of eight patients. Malignant disease developed in some celiacs with normal splenic size and function. Splenic function as measured by pitted erythrocyte counts was similar in the celiac patients with malignancy and appropriately matched nonmalignant celiacs. We conclude that hyposplenism in celiac disease does not influence the development of malignant disease.     

How Does Alcohol Contribute to Sexual Assault? Explanations from Laboratory and Survey Data

This article summarizes the proceedings of a symposium of the 2001 RSA Meeting in Montreal, Canada. The chair was Antonia Abbey and the organizers were Tina Zawacki and Philip O. Buck. There were four presentations and a discussant. The first presentation was made by Maria Testa whose interviews with sexual assault victims suggest that there may be differences in the characteristics of sexual assaults in which both the victim and perpetrator were using substances as compared to when only the perpetrator was using substances. The second presentation was made by Tina Zawacki whose research found that perpetrators of sexual assaults that involved alcohol were in most ways similar to perpetrators of sexual assaults that did not involve alcohol, although they differed on impulsivity and several alcohol measures. The third presentation was made by Kathleen Parks who described how alcohol consumption affected women's responses to a male confederate's behavior in a simulated bar setting. The fourth presentation was made by Jeanette Norris who found that alcohol and expectancies affected men's self-reported likelihood of acting like a hypothetical sexually aggressive man. Susan E. Martin discussed the implications of these studies and made suggestions for future research.     

Does Disruption of Circadian Rhythms Contribute to Beta-Cell Failure in Type 2 Diabetes?

Type 2 diabetes mellitus (T2DM) is a complex metabolic disease characterized by the loss of beta-cell secretory function and mass. The pathophysiology of beta-cell failure in T2DM involves a complex interaction between genetic susceptibilities and environmental risk factors. One environmental condition that is gaining greater appreciation as a risk factor for T2DM is the disruption of circadian rhythms (eg, shift-work and sleep loss). In recent years, circadian disruption has become increasingly prevalent in modern societies and consistently shown to augment T2DM susceptibility (partly mediated through its effects on pancreatic beta-cells). Since beta-cell failure is essential for development of T2DM, we will review current work from epidemiologic, clinical, and animal studies designed to gain insights into the molecular and physiological mechanisms underlying the predisposition to beta-cell failure associated with circadian disruption. Elucidating the role of circadian clocks in regulating beta-cell health will add to our understanding of T2DM pathophysiology and may contribute to the development of novel therapeutic and preventative approaches.     

Does the metabolic syndrome add to the diagnosis and treatment of cardiovascular disease?

Much controversy has surrounded both the pathological basis and the clinical utility of the metabolic syndrome. Key questions still revolve around the definition of this syndrome, its utility as a predictor of cardiovascular risk, and the treatment implications of diagnosis. The metabolic syndrome is associated with increased cardiovascular risk. However, the metabolic syndrome clearly underperforms compared with other, established prediction equations, such as the Framingham Risk Score and SCORE (Systemic COronary Risk Evaluation). Differences arise because the components are highly correlated (whereas other tools specifically include independent predictors) and because diagnosis is based on dichotomized variables. These facts, together with uncertain pathophysiology, mean that the metabolic syndrome in its current manifestation has limited utility for the diagnosis and treatment of cardiovascular disease. The syndrome has, however, served and continues to serve a useful purpose in raising awareness of the metabolic consequences of obesity, and as a spur for research into metabolic risk factor interactions.     

Can an Oral Mechanism Examination Contribute to the Assessment of Odds of Aspiration?

Use of an oral mechanism examination is ubiquitous and long-standing despite a paucity of research supporting its clinical utility in dysphagia diagnostics. The purpose of this study was to investigate whether components of an oral mechanism examination, i.e., binary judgments (complete/incomplete) of labial closure, lingual range of motion, and facial symmetry, were associated with increased odds of aspiration as confirmed by subsequent instrumental testing. Study design was a single-group consecutively referred case series with a single judge. A total of 4,102 consecutive inpatients from a large, urban, tertiary-care teaching hospital were accrued, with 3,919 meeting the inclusion criterion of adequate cognitive ability to participate in an oral mechanism examination followed immediately by a fiberoptic endoscopic evaluation of swallowing. Stepwise multiple logistic regression analysis indicated that participants with incomplete lingual range of motion had an odds of aspiration that was 2.72 times the odds of aspiration of those with complete lingual range of motion (95 % confidence interval [CI] = 1.96–3.79, p < 0.0001), and incomplete lingual range of motion was an independent risk factor for aspiration regardless of labial closure and facial symmetry. Participants with incomplete facial symmetry had an odds of aspiration that was 0.76 times the odds of aspiration of those with complete facial symmetry (95% CI = 0.61–0.95, p = 0.017). Isolated incomplete labial closure did not affect the odds of aspiration (p > 0.05). New and clinically relevant information was found for lingual range of motion and facial symmetry, i.e., when incomplete, the clinician should be alerted to potential increased odds of aspiration during subsequent instrumental dysphagia testing.     

Does Ammonia Contribute to Increased GABA-ergic Neurotransmission in Liver Failure?

The ammonia and GABAergic neurotransmission hypotheses of the pathogenesis of hepatic encephalopathy (HE) have appeared to be unrelated and perhaps mutually exclusive. Observations in animal models of fulminant hepatic failure, that are consistent with increased GABAergic inhibitory neurotransmission contributing to the manifestations of HE, include: (i) abnormal visual evoked potential waveforms that resemble those induced by GABA_A/benzodiazepine (BZ) receptor complex agonists; (ii) GABA_A/BZ receptor complex antagonist-induced ameliorations of encephalopathy; (iii) increased resistance to drugs which decrease GABAergic tone; and (iv) hypersensitivity of CNS neurons to depression by GABA_A/BZ receptor complex agonists. Mechanisms of increased GABAergic tone in HE may include the following: (i) increased brain concentrations of natural BZs; and (ii) increased GABA concentrations in synaptic clefts, possibly due to increased blood-brain-barrier permeability to GABA and a decrease in GABA_B receptor density. Both neuroelectrophysiological and behavioral data indicate that ammonia concentrations in the range 0.75-2 mM induce increased excitatory neurotransmission. In contrast, recently, ammonia concentrations in the range 0.15-0.75 mM, i.e. concentrations that commonly occur in plasma in precoma HE, have been shown: (i) to increase GABA-induced chloride current in cultured neurons; and (ii) to enhance synergistically the binding of GABA_A/BZ receptor agonists. In addition, increased ammonia concentrations enhance synthesis of neurosteroids in astrocytes, and some neurosteroids potently augment GABAergic neurotransmission. Thus, the modestly elevated concentrations of ammonia, that commonly occur in liver failure, may contribute to the manifestations of HE by enhancing GABAergic inhibitory neurotransmission. This concept appears to unify the ammonia and GABAergic neurotransmission hypotheses.     

Can Japan Contribute to the Post Millennium Development Goals? Making Human Security Mainstream through the TICAD Process

In 2013, the fifth Tokyo International Conference on African Development (TICAD V) will be hosted by the Japanese government. TICAD, which has been held every five years, has played a catalytic role in African policy dialogue and a leading role in promoting the human security approach (HSA). We review the development of the HSA in the TICAD dialogue on health agendas and recommend TICAD’s role in the integration of the HSA beyond the 2015 agenda. While health was not the main agenda in TICAD I and II, the importance of primary health care, and the development of regional health systems was noted in TICAD III. In 2008, when Japan hosted both the G8 summit and TICAD IV, the Takemi Working Group developed strong momentum for health in Africa. Their policy dialogues on global health in Sub-Saharan Africa incubated several recommendations highlighting HSA and health system strengthening (HSS). HSA is relevant to HSS because it focuses on individuals and communities. It has two mutually reinforcing strategies, a top-down approach by central or local governments (protection) and a bottom-up approach by individuals and communities (empowerment). The “Yokohama Action Plan,” which promotes HSA was welcomed by the TICAD IV member countries. Universal health coverage (UHC) is a major candidate for the post-2015 agenda recommended by the World Health Organization. We expect UHC to provide a more balanced approach between specific disease focus and system-based solutions. Japan’s global health policy is coherent with HSA because human security can be the basis of UHC-compatible HSS.