Changing epidemiology of hepatitis A infection in Izmir, Turkey

The seroprevalence study was conducted in order to determine the current seroepidemiology hepatitis A in Izmir, Turkey and to evaluate the epidemiological shift in HAV serostatus. Blood samples collected from 595 subjects aged 1-60 years were analyzed for anti-HAV IgG antibodies. The current study results were compared with those of a previous study conducted in 1998 involving the same location. There was a marked decrease in the prevalence of anti-HAV between 1998 and 2008. While anti-HAV seroprevalence rates in the current study were 4.6% in children aged 1-4 years, 23% in children aged 10-14 years, and 85% in young adults aged 20-29 years, the prevalence rates were 36% in the 1-4 years age group, 65% in the 10-14 years age group, and 95% in young adults in the previous study, indicating a shift in HAV seroprevalence from the younger to the higher age groups. As HAV infection in childhood is decreasing, the pool of susceptible adolescents and young adults is increasing in Izmir, Turkey. The majority of adolescent population is susceptible to HAV infection. The potential risk of HAV epidemics still exists. The situation of Turkey, suggested to need for mass immunization. Also, introduction of hepatitis A vaccination into the national immunization schedule of Turkey should be considered.     

Determinants of influenza and pertussis vaccine uptake in pregnant women in Ireland: A cross-sectional survey in 2017/18 influenza season

In Ireland seasonal influenza and pertussis vaccination during pregnancy is recommended and every year national campaigns are organised to raise awareness and improve uptake. We estimated influenza and pertussis vaccine uptake and identified factors associated with vaccination status in pregnant women in 2017/18.We conducted a face-to-face omnibus survey, with quota sampling, among women aged 18–55 years and collected socio-demographic characteristics, self-reported vaccination status, awareness of vaccine campaigns, and attitudes towards vaccination. Sample was weighted to ensure representativeness with the target population. We performed univariate and multivariable logistic regression analyses on survey data.Overall, 241 pregnant women were enrolled. Influenza and pertussis vaccine uptake was 61.7% and 49.9%, respectively. Awareness of vaccine campaign and socio-economic status (SES) were associated with both influenza and pertussis vaccine uptake. The association between SES and uptake of vaccines differed by awareness. Women aware of the influenza vaccine campaign and with mid and low SES were less likely to be vaccinated, compared to those with high SES (aOR = 0.46; 95%CI: 0.22–0.97; aOR = 0.27; 95%CI: 0.12–0.60, respectively); women not aware of the pertussis vaccine campaign and with mid and low SES were less likely to be vaccinated, compared to those aware and with high SES (aOR = 0.15; 95%CI: 0.04–0.48; aOR = 0.05; 95%CI: 0.01–0.24, respectively).General practitioner (GP) recommendation was the main reason for receiving influenza vaccine (39.2%), and 71.8% of women were recommended pertussis vaccination from their GPs.The survey reports moderate uptake of vaccines among pregnant women, inequalities in uptake by SES and identifies GPs as primary source for vaccine recommendation. We recommend multifaceted campaigns, by engaging GPs, to target all socio-economic groups.     

Hepatitis A incidence,seroprevalence, and vaccination decision among MSM in Amsterdam,the Netherlands

BackgroundSeveral outbreaks of Hepatitis A virus (HAV) were recently documented among men who have sex with men (MSM) in Europe. We investigated the HAV incidence among MSM in Amsterdam, the Netherlands; and HAV seroprevalence and HAV vaccination decision among MSM visiting the Sexually Transmitted Infection (STI) clinic in Amsterdam.MethodsUsing surveillance data from 1992 to 2017 of MSM with acute HAV in Amsterdam, we estimated the incidence by calendar year and age. We explored HAV seroprevalence by calendar year and age, determinants for HAV seropositivity, and opting-in/out for HAV vaccination using data collected among MSM that visited the STI clinic between 2006 and 2017 and were included in a nationwide Hepatitis B virus (HBV) vaccination programme. Offering HAV vaccination at the STI clinic differed over three consecutive periods: not offered, offered for free, or offered for 75 euros. Logistic regression analyses were used to explore determinants.ResultsHAV incidence increased in 2016/17 after 4 years of absence and peaked in MSM around 35 years of age. Among MSM visiting the STI clinic, HAV seroprevalence was 37% (95%CI = 35–40%), which was constant over the period 2006–2017, and increased with age (p < 0.001). Determinants for HAV seropositivity in multivariable analysis were: older age (p < 0.001), originating from an HAV endemic country (p < 0.001), and being HBV seropositive (p = 0.001). MSM opted-in more frequently when HAV vaccination was offered for free versus paid (89% versus 11%, respectively; p < 0.001). Younger MSM were less inclined to vaccinate when payment was required (p = 0.010). Post-hoc analyses showed that 98% versus 46% of MSM visiting the Amsterdam STI clinic would be protected against HAV infection if HAV vaccination was offered for free or for 75 euros, respectively.ConclusionsThe MSM population of Amsterdam is vulnerable to a new HAV outbreak. We strongly recommend that MSM have access to free hepatitis A vaccination.     

Estimating Bordetella pertussis seroprevalence in adolescents and young adults in Mexico using the 2012 National Health and Nutrition Survey (ENSANUT)

BackgroundLow vaccination rates and under-detection of pertussis infections in adolescents and young adults have an impact on the transmission of pertussis to infants. In this study, the proportion of adolescents and young adults with IgG antibodies against B. pertussis antigens, representing recent infection or vaccination, was estimated in a population-based probabilistic survey in Mexico.MethodsSera and data from 1,581 subjects, including 1,102 adolescents and 479 young adults (10–19 and 20–25 years old, respectively) randomly selected from Mexico’s 2012 National Health and Nutrition Survey, were analyzed. IgG antibodies against pertussis toxin (PT) were measured with the CDC/FDA ELISA. A subset of 234 samples was additionally tested with Bp-IgG PT ELISA kit (EUROIMMUN AG, Lubeck, Germany). Threshold values from corresponding test kits were used to identify recent infection or vaccination.ResultsOverall anti-PT IgG seroprevalence was 3.9% (95% CI: 2.3–6.3); 3.1% (95% CI: 1.9–5.0) in adolescents, and 4.9% (95% CI: 2.2–11) in young adults. Seroprevalence did not significantly vary by sex, socioeconomic status, region or rural/urban location. Compared to the CDC/FDA ELISA, the EUROIMMUN test showed a 76% sensitivity and 88% specificity. The weighted estimates represent a considerable burden of recent infection in adolescents and young adults; however, most adolescents and adults were seronegative and, therefore, susceptible to pertussis infection.ConclusionSince booster vaccination to B. pertussis after toddlerhood is not recommended in the Mexican national policy, anti-PT IgG seropositivity may be reasonably attributed to recent infection. Assessing pertussis seroprevalence requires careful consideration of the diagnostic test threshold interpretation and epidemiological model used.     

Seroepidemiology of hepatitis A and hepatitis B virus in Luxembourg

A prospective seroepidemiological survey was carried out in Luxembourg in 2000-2001 to determine the antibody status of the Luxembourg population against hepatitis A virus (HAV) and hepatitis B virus (HBV). One of the objectives of this survey was to assess the impact of the hepatitis B vaccination programme, which started in May 1996 and included a catch-up campaign for all adolescents aged 12-15 years. Venous blood from 2679 individuals was screened for the presence of antibodies to HAV antigen and antibodies to hepatitis B surface antigen (anti-HBs) using an enzyme immunoassay. Samples positive for anti-HBs were tested for antibody to hepatitis B core antigen (anti-HBc) using a chemiluminiscent microparticle immunoassay to distinguish between individuals with past exposure to vaccine or natural infection. The estimated age-standardized anti-HAV seroprevalence was 42.0% [95% confidence interval (CI) 39.8-44.1] in the population >4 years of age. Seroprevalence was age-dependent and highest in adult immigrants from Portugal and the former Yugoslavia. The age-standardized prevalence of anti-HBs and anti-HBc was estimated at 19.7% (95% CI 18.1-21.3) and 3.16% (95% CI 2.2-4.1) respectively. Anti-HBs seroprevalence exceeding 50% was found in the cohorts targeted by the routine hepatitis B vaccination programme, which started in 1996. Our study illustrates that most young people in Luxembourg are susceptible to HAV infection and that the hepatitis B vaccination programme is having a substantial impact on population immunity in children and teenagers.     

Age-specific seroprevalence of hepatitis A infection among children visited in pediatric hospitals of Tehran, Iran

BACKGROUND: Hepatitis A is an enterically transmitted disease that still remains endemic in many developing countries. In some countries improvements in living conditions have recently led to changing in epidemiology of hepatitis A virus (HAV) infection. In our country there are very few reports on prevalence of HAV infection. OBJECTIVE: To determine the seroprevalence of anti-HAV IgG among children visited in pediatric hospitals of Tehran, Iran. METHODS: The study group included 1018 children who were 6 months-14.9 years of age. These children were visited in four major pediatric hospitals of Tehran. The children were separated to three age groups: Group 1 (6 months-4.9 years; n = 469), Group 2 (5.0-9.9 years; n = 290), and Group 3 (10.0-14.9 years; n = 259). Serum anti-HAV IgG was tested with commercial ELISA kits. The data were tested for statistical significance with chi2 test. RESULTS: In all subjects, seroprevalence of hepatitis A was 22.3% (95% CI: 19.7, 24.9). There was no significant difference between genders (22.2% vs. 22.5% in males and females, respectively) and among age groups (Group I was 22.1% and Group 3 was 25.9; p > 0.05). CONCLUSIONS: In summary, it seems that HAV infection is not highly endemic at least in some urban areas of Iran. On the basis of this epidemiologic data, post exposure prophylaxis would be necessary for children and young adults, and hepatitis A vaccination strategy should be revised.     

Socio-Economic Determinants and Self-Reported Depressive Symptoms During Postpartum Period

The researchers' aims were to estimate the prevalence of postpartum depressive symptoms in Italy. Cross-sectional data from the survey, “Health and use of health care in Italy” were analyzed. The authors focused on 5,812 women, pregnant some time during five years before the survey. Multiple logistic regression was used to evaluate risk factors independently associated with postpartum depressive symptoms. Evaluation of seasonal trends was also performed.In the total sample, 23.5% (n = 1,365) reported having suffered postpartum depressive symptoms: 20.7% experienced baby blues, and 2.8% postpartum depression. Factors significantly associated with baby blues were, among others, living in northern or central areas (adjusted odds ratio [aOR] 1.88; 95%CI 1.57–2.15 and 1.40; 95%CI 1.20–1.63, respectively), history of depression (aOR 1.34; 95%CI 1.15–1.56), and attendance at antenatal classes (aOR 1.13; 95%CI 1.04–1.22). Factors significantly associated with postpartum depression were: anamnesis of depression (aOR 3.32; 95%CI 2.69–4.09), gaining more than 16 kg of weight during pregnancy (aOR 1.48; 95%CI 1.03–2.12), and undergoing a cesarean section (planned: aOR 1.56; 95%CI 1.05–2.29; unplanned: aOR 1.78; 95%CI 1.16–2.73). Multiparity was a protective factor both for baby blues (aOR 0.80; 95%CI 0.70–0.91), and postpartum depression (aOR 0.71; 95%CI 0.51–0.98). No clear seasonality was observed for postpartum depression, while for baby blues a certain aggregation of events was registered during the central months of the year. The authors' study highlighted variables associated with baby blues and postpartum depression to target screening for women for postpartum depressive symptoms.     

Determinants of school injury proneness in adolescents: a prospective study

OBJECTIVE: Injury proneness is common in adolescents, but the role of individual factors has received little attention. This study assessed the relationships of a number of individual characteristics with frequency of school injuries. METHODS: This prospective study was conducted on 2396 students from middle schools and high schools in an urban area in France over one school year. A questionnaire was completed by each student at the beginning of the school year, and an injury questionnaire was completed for all injuries that occurred at school during the year. Data were analysed using the chi2 independence test and logistic models. RESULTS: Over the study year, 10.6% of the students had a single injury. Frequent injuries (two or more) were common (2.3%) and were strongly related to younger age [adjusted odds ratio (aOR) 1.52, 95% confidence interval (95%CI) 1.28-1.79], frequent use of psychotropic drugs (aOR 2.03, 95%CI 1.06-3.86) and a poorer average school mark (<10/20, aOR 2.58, 95%CI 1.30-5.12). The occurrence of a single injury was less strongly related to younger age (aOR 1.20, 95%CI 1.11-1.30) and frequent use of psychotropic drugs (aOR 1.43, 95%CI 1.04-1.96), and was also associated with parental absence (aOR 1.33, 95%CI 1.00-1.77), not being calm (aOR 1.41, 95%CI 1.03-1.89) and not being easily irritated (aOR 1.56, 95%CI 1.14-2.13). CONCLUSIONS: This study identified a number of factors associated with injury frequency. This information could be useful for injury prevention. Physicians could help students, parents, teachers and school staff to be more aware of the risks and to find remedial measures.     

Hepatitis A and B seroprevalence in Macaé, Rio de Janeiro State,Brazil

Total HAV and HBc seroprevalence rates in two socioeconomic groups in Macaé, Rio de Janeiro State, Brazil, were estimated in 1,100 surplus serum samples from routine laboratory tests identified by sex, age, neighborhood, and category of medical care, i.e., the public health system or National Unified Health System (SUS) as compared to private health services (NSUS). Seroprevalence rates by age, 95% confidence intervals, and statistical significance tests for differences between SUS and NSUS are presented. Distribution of seroprevalence rates (P) for total HAV (P = 88.8%; 95% CI = 86.8-90.6) and total HBc (P = 15.3%; 13.2-17.6) by age showed an ascending curve. Prevalence rates in the SUS group were significantly higher that in the NSUS group, for both HAV (chi2 = 31.15; p < 0.0001) and HBV (chi2 = 15.41; p < 0.0001). The high prevalence rates reflect the epidemiological pattern of HAV infection in developing countries and the relevance of the social and environmental context. The proportion of susceptible individuals in the < 5 and > 20 year groups highlights the need to vaccinate for hepatitis A and the potential increase in severe cases. High HVB prevalence among adolescents underscores the importance of vaccinating this group. The results serve as a reminder to health professionals concerning biosafety norms.     

Changes in seroprevalence to hepatitis A in Victoria, Australia: A comparison of three time points

Serological data provide an important measure of past exposure and immunity to hepatitis A virus (HAV) infection in a population. National serosurveys from developed countries have typically indicated a decline in HAV seroprevalence over time as sanitation levels improve. We examined trends in the seroepidemiology of HAV antibodies in Victoria, Australia, drawing on cross-sectional samples taken at three time points over a 20-year period. Stored sera from 1988 (n=753), 1998 (n=1091), and 2008 (n=791) from persons aged 1-69 years were obtained from the state of Victoria, Australia. The within-year population adjusted results show a significant trend of increasing population HAV seroprevalence over time from 34.3% (95% CI 31.7-36.9) in 1988, to 40.0% (95% CI 37.1-42.8) in 1998 and 55.1% (95% CI 52.1-58.1) in 2008, P<0.0001. A particularly noticeable rise in population seroprevalence was observed between 1998 and 2008 for those aged 5-39 years. The increase in HAV seropositivity over time is in contrast to the declining rates of disease notification in Australia. Based on comparisons with other Australian data, it appears the increase in population seroprevalence over the last two decades is unlikely to be due to endemic transmission of infection. Instead, other factors, including increases in travel to HAV endemic regions, migration to Australia from HAV endemic regions and vaccine uptake are more likely causes. Ongoing monitoring of serological HAV profiles in the population is required to determine future policy direction to prevent increased burden.     

Prevalence and risk factors of hepatitis A infection in an HIV-infected French population

BACKGROUND: There are common risk factors between hepatitis A virus (HAV) and human immuno deficiency virus (HIV) infections. OBJECTIVES: We tried to evaluate if HIV-infected patients could be at risk for HAV. More over, HAV could worsen prognosis of HIV infection and HAV vaccination was then to be considered. Thus we assessed the prevalence and risk factors of HAV infection in an HIV-infected population. PATIENTS AND METHODS: Seroprevalence and risk factors for HAV were studied among 154 HIV-positive patients followed in a Parisian hospital (mean age: 42 years, male patients: 70.8%, female patients: 29.2%). They were screened for HAV antibodies and answered a questionnaire on risk factors for HAV and means of HIV contamination. RESULTS: The global prevalence was 72.7% [IC95%: 65.7-79.7]. We excluded patients who were born in highly endemic areas where seroprevalence reached 60% [IC95%: 51.2-70]. The HAV seroprevalence was almost 100% in migrants from highly endemic countries and for those born before 1946. The multivariate analysis showed that risk factors were the geographic origin [OR=20.88; IC95%: 2.40-181], age [OR = 2.33; IC95%: 1.24-4.39], and hemophilia [OR = 13.78; IC95%: 1.34-141]. CONCLUSION: Our results suggest that a screening test for HAV antibodies should be performed before vaccination, especially in HIV-infected patients born after 1946 or in non-endemic countries.     

Seroepidemiology of Hepatitis A Infection in Northeastern China,Korea, and Japan

ObjectivesThe epidemiological patterns of endemic hepatitis A virus (HAV) are unclear in northeastern Asia depending on the ethnicity of the country in question. The purpose of this study was to investigate the seroprevalence of HAV in northeastern China, South Korea, and Japan.MethodsA total of 1,500 serum samples were collected from five groups of inhabitants (300 each) who were over 40 years of age (Korean Chinese, indigenous Chinese, South Korean, Korean living in Japan, and indigenous Japanese). The samples were screened for antibodies to HAV using an enzyme-linked immunosorbent assay.ResultsPositivity for HAV antibodies was 93.7% (95% confidence interval [CI]: 90.9–96.4) in Koreans living in northeastern China, 99.7% (95% CI: 99.0–100.3) in indigenous Chinese, 98.0% (95% CI: 96.4–99.6) in indigenous Koreans, 33.3% (95% CI: 28.0–38.7) in Koreans living in Japan, and 20.4% (95% CI: 15.8–25.0) in indigenous Japanese persons. The overall anti-HAV prevalence was not significantly different between northeastern China and South Korea, but it was different in Japan.ConclusionsThese results indicate that differences in seroprevalence can be attributed to geological, environmental, and socioeconomic conditions rather than ethnicity.     

Associations between sport participation, demographic and socio-cultural factors in Portuguese children and adolescents

BACKGROUND: The number of studies that focus on factors influencing the sport participation (SP) of children and adolescents is limited. The present study examines the associations between demographic [age, gender and socio-economic status (SES)] and socio-cultural factors (SP of family, and peers and physical educator influences) and the SP of children and adolescents. METHODS: A random sample of 3352 Portuguese children/adolescents, 10-18 years, their parents and siblings was surveyed. The assessment of SP was based on a psychometrically established questionnaire. Multivariable logistic regression was used in data analysis. RESULTS: (i) age was not related to children/adolescent's SP; (ii) children/adolescents with high SES (OR:1.7, 95%CI:1.4-2.2) and medium SES (OR:1.4, 95%CI:1.1-1.7) were more involved in sports; (iii) children/adolescents were more likely to participate in sports when their family also participate; (iv) boys were more likely to participate in sports than girls (adjusted OR:3.3, 95%CI:2.8-3.9 from a main effects model), but mother's SP influenced their daughters and sons differently. Daughters showed a greater propensity for practising sports when their mothers did (OR:2.5; 95%CI:1.7-3.6). For sons, sports involvement was similar whether or not their mothers participated (OR:1.1; 95%CI:0.7-1.7); (v) peers had a positive influence on the participants' SP (OR:2.2, 95%CI:1.9-2.7); (vi) after adjusting for other factors, the influence of a physical education teacher was not found to affect the SP of the children/adolescents. CONCLUSION: There are important demographic and socio-cultural influences on the SP of children/adolescents-in particular, gender, SES, family members' SP and peer influence.     

Willingness and influential factors of parents to vaccinate their children with novel inactivated enterovirus 71 vaccines in Guangzhou,China

Hand, foot and mouth disease (HFMD) primarily affects children younger than 5 years of age. Recently, HFMD has ranked as the top notifiable infectious disease in China. In December 2015, China approved two novel inactivated enterovirus 71 vaccines (EV71 vaccines) for HFMD. Parents’ acceptance is often essential for vaccination program success. The goal of this study was to identify willingness and influential factors to vaccinate among parents of kindergarteners in Guangzhou, China. A cross-sectional survey of face-to-face interviews was conducted from March to July 2016. Fifty-five kindergartens were randomly selected from 11 districts of Guangzhou. An anonymous self-designed questionnaire was used to investigate awareness, knowledge and attitude towards HFMD and EV71 vaccines. A total of 868 parents participated in the survey. Mean(±standard deviation) knowledge score of HFMD was 6.32(±1.70). Approximately 32.03% of parents had heard of the EV71 vaccines with 22.58% receiving information before this study. Nearly 44.24% of parents showed willingness to vaccinate their children. Previously receiving EV71 vaccine-related information [adjusted odds ratio (aOR) = 1.48, 95% confidence interval (CI): 1.04–2.11], no fear of adverse effects (aOR = 4.25, 95%CI: 2.77–6.53), perceived susceptibility of children to HFMD (aOR = 2.15, 95%CI: 1.42–3.25) and children not previously diagnosed with HFMD (aOR = 1.56, 95%CI: 1.07–2.27) were positively associated with EV71 vaccination acceptability. However, parental education background (aOR = 0.54, 95%CI: 0.37–0.80) was negatively correlated with vaccination acceptability. Our study provides baseline information for future vaccination campaigns to help improve the EV71 vaccine uptake rate. Special efforts are urgently needed to improve the awareness and knowledge of EV71 vaccines in China.     

珠海市大学生预防艾滋病健康教育意愿及需求调查

目的 了解珠海市大学生接受预防AIDS健康教育的意愿及需求,为进一步开展AIDS教育提供依据。 方法 采用现况研究的方法,于2019年10月至12月在珠海市6所高校招募学生参加调查,收集AIDS教育意愿和需求及相关因素等信息。采用多因素非条件logistic回归模型分析大学生接受AIDS教育意愿的影响因素。结果 94.06%（11508/12235）的学生愿意接受AIDS教育;其中女生（aOR=3.40,95%CI:2.81~4.12）、住宿生（aOR=2.23,95%CI:1.46~3.42）、每月可支配收入为0~（aOR=1.94,95%CI:1.45~2.61）和2000~（aOR=1.95,95%CI:1.47~2.60）的学生更倾向于愿意接受该教育;大二（aOR=0.80,95%CI:0.65~0.98）、大三（aOR=0.62,95%CI:0.50~0.77）、大四/大五（aOR=0.63,95%CI:0.48~0.83）的学生接受意愿低于大一新生;理工类（aOR=0.42,95%CI:0.18~0.96）、艺体类（aOR=0.31,95%CI:0.13~0.72）的学生接受意愿低于医学生;性取向为同性恋（aOR=0.35,95%CI:0.21~0.60）、双性恋（aOR=0.70,95%CI:0.50~0.97）或不确定者（aOR=0.45,95%CI:0.35~0.57）相对于异性恋者更不愿意接受该教育。91.40%（11184/12235）的学生报告接受过AIDS相关知识,部分知识希望接受率高于实际接受率;传授及宣传材料是其获取AIDS相关知识的主要途径和青睐的接受途径,媒体和同伴教育等当前比较受学生欢迎的宣教方式则存在开展不足的问题。结论 珠海市大学生接受AIDS教育的意愿较高,但教育的内容及途径与实际需求尚有差距。建议高校紧跟AIDS教育趋势,针对学生接受AIDS教育意愿和需求的薄弱环节,提升学生风险防范意识和培养正确预防AIDS的行为方式。     

Changing risk profile of hepatitis A in The Netherlands: a comparison of seroprevalence in 1995-1996 and 2006-2007

The prevalence of antibodies to hepatitis A virus (HAV) was assessed in a nationwide sample (n=6229) in The Netherlands in 2006-2007, and compared to the seroprevalence in a similar study in 1995-1996 (n=7376). The overall seroprevalence increased from 34% in 1995-1996 to 39% in 2006-2007, mainly due to vaccination of travellers and an increased immigrant population. Risk factors remain travelling to, and originating from, endemic regions, and vaccination is targeted currently at these risk groups. Our results show a trend of increasing age of the susceptible population. These people would also benefit from HAV vaccination because they are likely to develop clinically serious symptoms after infection, and are increasingly at risk of exposure through imported viruses through foods or travellers. The cost-effectiveness of adding elderly people born after the Second World War as a target group for prophylactic vaccination to reduce morbidity and mortality after HAV infection should be assessed.     

Factors associated with provision of depot medroxyprogesterone acetate to adolescents by US health care providers

ObjectiveIdentify factors associated with healthcare providers' frequency of depot medroxyprogesterone acetate (DMPA) provision to adolescents.Study designWe analyzed data from surveys mailed to a nationally representative sample of public-sector providers and office-based physicians (n=1984). We estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs) of factors associated with frequent DMPA provision to adolescents in the past year.ResultsAlthough most providers (>95%) considered DMPA safe for adolescents, fewer reported frequent provision (89% of public-sector providers; 64% of office-based physicians). Among public-sector providers, factors associated with lower odds of frequent provision included working in settings without Title X funding (aOR 0.44, 95% CI 0.30–0.64), reporting primary care as their primary clinical focus versus reproductive or adolescent health (aOR 0.42, 95% CI 0.28–0.61), and providing fewer patients with family planning services. Among office-based physicians, factors associated with lower odds of frequent provision included specializing in obstetrics/gynecology (aOR 0.50, 95% CI 0.27–0.91) and family medicine (aOR 0.21, 95% CI 0.09–0.47) versus adolescent medicine, completing training ≥15 versus <5 years ago (aOR 0.27, 95% CI 0.09–0.83), and reporting that 0–24% of patients pay with Medicaid or other government healthcare assistance versus ≥50% (aOR 0.23, 95% CI 0.09–0.61). The reason most commonly reported by providers for infrequent DMPA provision was patient preference for another method.ConclusionsWhile most providers reported frequently providing DMPA to adolescents, training on evidence-based recommendations for contraception, focused on subgroups of providers with lower odds of frequent DMPA provision, may increase adolescents' access to contraception.ImplicationsAlthough >95% of providers considered depot medroxyprogesterone (DMPA) a safe contraceptive for adolescents, only 89% of public-sector providers and 64% of office-based physicians reported frequently providing DMPA to adolescents. Provider training on evidence-based recommendations for contraception counseling and provision may increase adolescents' access to DMPA and all methods of contraception.     

Postpartum Depression in Adolescent and Adult Mothers: Comparing Prenatal Risk Factors and Predictive Models

Our objective was to assess whether postpartum depression risk factors differ between adolescent and adult mothers and to evaluate the need for adolescent specific screening instruments. We performed a retrospective cohort study using data from the Rhode Island Pregnancy Risk Assessment Monitoring System, 2004–2008. We identified maternal age specific risk factors using weighted logistic regression and developed predictive models using a forward selected weighted logistic regression. Notable differences in odds ratios were observed for risk factors such as maternal race (OR Hispanic vs. White: 0.99, 95 % CI 0.49–1.99 among adolescents; 3.32, 95 % CI 2.01–5.49 among adults), pre-pregnancy alcohol use (OR use vs. non-use: 2.04, 95 % CI 1.08–3.86 among adolescents; 0.49, 95 % CI 0.33–0.73 among adults), and pregnancy intention (OR unintended vs. intended: 1.05, 95 % CI 0.37–2.97 among adolescents; 2.67, 95 % CI 1.51–4.74 among adults). In predictive models, adolescent postpartum depressive symptoms were most influenced by prior depression and social support while adult postpartum depressive symptoms were associated with risk factors including maternal race, pregnancy intention, SES, prior depression, mental health during pregnancy, stressors, and social support. We were able to identify similarities and dissimilarities in risk factors for postpartum depressive symptoms among adolescents and adults. Predictive models developed in the general population of pregnant women performed poorly among adolescents relative to age specific predictive models, suggesting that current screening tools may not adequately identify high risk adolescents.     

Association and Interaction Effect of BHMT Gene Polymorphisms and Maternal Dietary Habits with Ventricular Septal Defect in Offspring

This study attempted to learn the association between maternal betaine-homocysteine methyltransferase (BHMT) gene polymorphisms, maternal dietary habits, and their interactions with the risk of ventricular septal defects (VSD) in offspring. A total of 426 mothers of VSD children and 740 control mothers were included in the study. Logistic regression was used to evaluate the level of associations and interaction effects. Our study suggested that mothers reporting excessive intake of smoked foods (aOR = 2.44, 95%CI: 1.89–3.13), barbecued foods (aOR = 1.86, 95%CI: 1.39–2.48), fried foods (aOR = 1.93, 95%CI: 1.51–2.46), and pickled vegetables (aOR = 2.50, 95%CI: 1.92–3.25) were at a significantly higher risk of VSD in offspring, instead, mothers reporting regular intake of fresh fruits (aOR = 0.47, 95%CI: 0.36–0.62), fish and shrimp (aOR = 0.35, 95%CI: 0.28–0.44), fresh eggs, (aOR = 0.56, 95%CI: 0.45–0.71), beans (aOR = 0.68, 95%CI: 0.56–0.83), and milk products (aOR = 0.67, 95%CI: 0.56–0.80) were at a lower risk of VSD in offspring. In addition, maternal BHMT gene polymorphisms at rs1316753 (CG vs. CC: aOR = 2.01, 95%CI: 1.43–2.83) and rs1915706 (CT vs. TT: (aOR = 1.81, 95%CI: 1.33–2.46) were significantly associated with increased risk of VSD in offspring. Furthermore, a significant interaction between BHMT polymorphisms and maternal bean intake was identified in the study. In conclusion, Maternal BHMT polymorphisms at rs1316753 and rs1915706, dietary habits as well as their interaction were observed to be significantly associated with the risk of VSD in offspring.     

Vaccination against hepatitis A virus may not be required for schoolchildren in northern India: results of a seroepidemiological survey

OBJECTIVES: To evaluate the current seroprevalence of antibodies against hepatitis A virus (HAV) in a sample of schoolchildren above 10 years of age and to determine the prevalence of HAV-induced hepatitis in adults at a tertiary care hospital in northern India between January 1992 and December 2000. METHODS: Sera from 276 male and 224 female schoolchildren aged 10-17 years were tested for anti-HAV antibodies by enzyme-linked immunosorbent assay. Consecutive patients with a diagnosis of acute viral hepatitis who attended a liver clinic were tested for the serological markers of HAV, hepatitis B Virus, hepatitis C virus, hepatitis D virus, and hepatitis E virus. FINDINGS: Of the male and female children, 96.3% and 98.2%, respectively had anti-HAV antibodies in their sera. The prevalence of these antibodies in the age groups 10-12, 13- 14, and 15-17 years were 98.6%, 94.8%, and 98.3% respectively. The frequency of HAV- induced acute viral hepatitis (69/870, 8%) in adults did not show an increasing trend. CONCLUSION: Mass HAV vaccination may be unnecessary in northern India because the seroprevalence of protective antibodies against HAV in schoolchildren aged over 10 years remains above 95% and there has been no apparent increase in HAV-induced acute viral hepatitis in adults.