Does the interaction between maternal folate intake and the methylenetetrahydrofolate reductase polymorphisms affect the risk of cleft lip with or without cleft palate?

Periconceptional folic acid supplementation may reduce the risk of cleft lip with or without cleft palate (CL(P)). Polymorphisms in the methylenetetrahydrofolate reductase (MTHFR) gene reduce availability of 5-methyltetrahydrofolate, the predominant circulating form of folate. To determine the effect of MTHFR C677T and MTHFR A1298C genotypes and haplotypes on CL(P) risk and the interaction with maternal periconceptional dietary folate and folic acid supplement intake, the authors conducted a case-control triad study in the Netherlands (1998-2000) among 179 CL(P) and 204 control families. Infant and parental MTHFR C677T and MTHFR A1298C genotypes and haplotypes were not associated with CL(P) risk in the case-control and transmission disequilibrium test analyses. Mothers carrying the MTHFR 677TT genotype and who either did not use folic acid supplements periconceptionally or had a low dietary folate intake, or both, had an increased risk of delivering a CL(P) child (odds ratio (OR) = 5.9, 95% confidence interval (CI): 1.1, 30.9; OR = 2.8, 95% CI: 0.7, 10.5; OR = 10.0, 95% CI: 1.3, 79.1, respectively). No supplement use, low dietary folate intake, and maternal MTHFR 1298CC genotype increased the risk of CL(P) offspring almost sevenfold (OR = 6.5, 95% CI: 1.4, 30.2). Thus, the detrimental effect of low periconceptional folate intake on the risk of giving birth to a CL(P) child was more pronounced in mothers with the MTHFR 677TT or MTHFR 1298CC genotype.     

HIV and STDs: how are they linked?

I write in response to Dr. Gina Dallabeta's article with this title (HIV and STDs: How Are They Linked?). Prospective studies in sub-Saharan Africa have established the following: 1. Seropositive commercial sex workers have a higher prevalence of genital ulcer disease (GUD) and positive serology for syphilis. 2. Seropositive men with chancroid more frequently have a history of prior GUD. 3. Seronegative men with a history of recent contact with a commercial sex worker are more likely to seroconvert if they have GUD than urethritis. GUD increases the infectiousness of HIV. Similarly, there is increased susceptibility to the virus in cases of genital chlamydial infection and Trichomonas vaginalis. The mechanisms are basically two--mechanical and biological. Mechanically, the raw area resulting from the STD provides a portal of entry for the virus. Biologically, activated lymphocytes and macrophages enhance HIV shedding and increase the susceptibility of the individual to HIV.     

HIV and STDS: how are they linked?

The 153-327 million new cases of treatable sexually transmitted diseases (STDs) each year are a critical health problem and are increasingly associated with transmission of HIV infections. There is strong epidemiological evidence that STDs (especially HIV-1 and genital ulcer diseases such as syphilis, herpes, and chancroid) increase a person's ability to transmit or acquire an HIV infection. In addition, HIV may alter the clinical presentation, natural history, diagnosis, and responsiveness to therapy of STDs; and STDs may alter the natural history of HIV infection by inducing immunosuppression, by chronic immune stimulation, or by direct viral interactions. Most reports on HIV infection and syphilis document neurological manifestation of syphilis in HIV-1 infected individuals. HIV-1 may modify an individual's response to syphilis infection, producing more persistent and higher RPR titres, increasing the likelihood of losing reactivity to treponemal tests correlating with advanced HIV disease, and increasing biological false-positive reactions. HIV also appears to reduce the responsiveness of chancroid to standard therapy, especially single-dose therapy, thus requiring multiple-dose therapy over 5-7 days. Herpes simplex viral infections are more frequent and severe in HIV-infected individuals, but dosage adjusted acyclovir therapy is effective in most patients. Gonorrhea does not appear to be affected by the presence of HIV infection, except that HIV-infected women may be more susceptible to cervical gonococcal infection and pelvic inflammatory disease. The clinical presentation of human papilloma virus, however, is altered by HIV infection as is the rate of recurrence and the responsiveness to standard therapy. Because of the recognition of the interaction of HIV and STDs, STD control is now recognized as an essential component of HIV prevention programs. Parallel prevention campaigns, such as condom promotion, could reduce both.     

Medicare beneficiary counseling programs: what are they and do they work?

Medicare beneficiaries face myriad rules, conditions, and exceptions under the Medicare program. As a result, State Information, Counseling, and Assistance (ICA) programs were established or enhanced with Federal funding as part of the Omnibus Budget Reconciliation Act (OBRA) of 1990. ICA programs utilize a volunteer-based and locally-sponsored support system to deliver free and unbiased counseling on the Medicare program and related health insurance issues. This article discusses the effectiveness of the ICA model. Because the ICA programs serve as a vital link between HCFA and its beneficiaries, information about the programs' success may be useful to HCFA and other policymakers during this era of consumer information.     

Cellular phones: are they detrimental?

The issue of possible health effects of cellular phones is very much alive in the public's mind where the rapid increase in the number of the users of cell phones in the last decade has increased the exposure of people to the electromagnetic fields (EMFs). Health consequences of long term use of mobile phones are not known in detail but available data indicates the development of non specific annoying symptoms on acute exposure to mobile phone radiations. In an attempt to determine the prevalence of such cell phones associated health manifestations and the factors affecting their occurrence, a cross sectional study was conducted in five randomly selected faculties of Alexandria University. Where, 300 individuals including teaching staff, students and literate employee were equally allocated and randomly selected among the five faculties. Data about mobile phone's users and their medical history, their pattern of mobile usage and the possible deleterious health manifestations associated with cellular phone use was collected. The results revealed 68% prevalence of mobile phone usage, nearly three quarters of them (72.5%) were complainers of the health manifestations. They suffered from headache (43%), earache (38.3%), sense of fatigue (31.6%), sleep disturbance (29.5%), concentration difficulty (28.5%) and face burning sensation (19.2%). Both univariate and multivariate analysis were consistent in their findings. Symptomatic users were found to have significantly higher frequency of calls/day, longer call duration and longer total duration of mobile phone usage/day than non symptomatic users. For headache both call duration and frequency of calls/day were the significant predicting factors for its occurrence (chi2 = 18.208, p = 0.0001). For earache, in addition to call duration, the longer period of owning the mobile phone were significant predictors (chi2 = 16.996, p = 0.0002). Sense of fatigue was significantly affected by both call duration and age of the user (chi2 = 24.214, p = 0.0000), while burning sensation was only affected by frequency of calls/day (chi2 = 5.360, p = 0.020). According to the 95% confidence interval of frequency and duration of calls, the study recommended not to increase the call duration more than four minutes and limit their frequency to less than seven calls/day with total duration of exposure less than 22 min./day.     

Social insurance and elderly entitlement reform: are they compatible?

There is no inconsistency between Social Security and Medicare reform and a firm commitment to the concept of social insurance. The retirement benefit components of these programs are not part of social insurance. Social insurance allows for people who experience low-probability random bad events to be compensated by others. An event, such as reaching retirement age, is a high-probability event and not a candidate for social insurance.     

Health care expenditure and GDP: are they broken stationary?

In this paper, we analyse the stationarity of the real per capita health care expenditure (HCE) and real per capita GDP for a sample of OECD countries, allowing for the presence of multiple structural breaks. One novelty of the paper is that it permits the presence of structural breaks that affect both the level and the slope of the time series. After the cross-section dependence is accounted for, we have found that these variables can be characterised as stationary processes evolving around a broken trend.     

Friction and impact surfaces: are they lead-based paint hazards?

Professionals who identify residential lead-based paint hazards and develop lead hazard control plans are instructed to assess painted friction and impact surfaces in homes as potentially active sources of dust lead, a known exposure vector for young children. However, empirical tests of the importance of these surfaces had not been conducted. Using data collected as part of a 1998 three-community study of the Housing and Urban Development Lead Risk Assessment protocols, this article explores how much rubbing or binding on friction and impact surfaces on windows and doors influence dust lead levels on windowsills and floors, while taking into account paint condition on these surfaces and other sources of lead. The analyses included windowsill dust wipe samples from 611 rooms in 182 homes and 782 floor dust wipe samples collected in 209 rooms from 104 homes. The study found that when the paint on windows is intact but the window is rubbing or binding, the dust lead levels on the windowsills are significantly higher than on windows with intact paint without rubbing or binding, after controlling for other lead sources. Windowsill dust lead on a window with intact lead-based paint at 1 mg/cm(2) and no rubbing/binding would be 27% lower than on a window with nonintact paint, rubbing/binding surfaces, or both of these conditions. An independent effect of rubbing/binding of doors on floor dust lead loadings was not observed. These findings support federal regulations calling for lead risk assessors to check the friction/impact surfaces at windows when dust lead samples taken below them are elevated, but these analyses did not offer support for taking extra observations of friction/impact surfaces around doors.     

HIV and STDs: how are they linked? [letter

I write in response to Dr. Gina Dallabeta's article with this title (HIV and STDs: How Are They Linked?). Prospective studies in sub-Saharan Africa have established the following: 1. Seropositive commercial sex workers have a higher prevalence of genital ulcer disease (GUD) and positive serology for syphilis. 2. Seropositive men with chancroid more frequently have a history of prior GUD. 3. Seronegative men with a history of recent contact with a commercial sex worker are more likely to seroconvert if they have GUD than urethritis. GUD increases the infectiousness of HIV. Similarly, there is increased susceptibility to the virus in cases of genital chlamydial infection and Trichomonas vaginalis. The mechanisms are basically two--mechanical and biological. Mechanically, the raw area resulting from the STD provides a portal of entry for the virus. Biologically, activated lymphocytes and macrophages enhance HIV shedding and increase the susceptibility of the individual to HIV.     

Headaches from cellular telephones: are they real and what are the implications?

There have been numerous recent reports of headaches occurring in association with the use of hand-held cellular telephones. Are these reported headaches real? Are they due to emissions from telephones? There is reason to believe that the answer is "yes" to both questions. There are several lines of evidence to support this conclusion. First, headaches as a consequence of exposure to low intensity microwaves were reported in the literature 30 years ago. These were observed during the course of microwave hearing research before there were cellular telephones. Second, the blood-brain barrier appears to be involved in headaches, and low intensity microwave energy exposure affects the barrier. Third, the dopamine-opiate systems of the brain appear to be involved in headaches, and low intensity electromagnetic energy exposure affects those systems. In all three lines of research, the microwave energy used was approximately the same--in frequencies, modulations, and incident energies--as those emitted by present day cellular telephones. Could the current reports of headaches be the canary in the coal mine, warning of biologically significant effects?