Diversity and sharing of Haemophilus influenzae strains colonizing healthy children attending day-care centers

BACKGROUND: Children attending day-care centers (DCCs) are at risk for Haemophilus influenzae nasopharyngeal colonization and acute otitis media. The degree to which a given strain circulates within a day-care center and the heterogeneity of strains among DCCs in a geographic area are not well-characterized. This study describes the prevalence rates of H. influenzae colonization in a large number of children attending day-care centers and examines the genetic diversity of colonizing strains and the degree of sharing among children. METHODS: Throat cultures were collected from 198 healthy children <3 years old attending 16 day-care centers in Michigan. All H. influenzae isolates were genetically typed by enterobacterial repetitive intergenic consensus PCR as the initial screening technique to identify unique strains within each child. Pulsed field gel electrophoresis was used subsequently to examine the genetic diversity of strains between children. RESULTS: There were 127 (64%) children colonized with H. influenzae. Wide variation in rates of colonization was identified among day-care centers (0 to 95%). A total of 179 genetically unique H. influenzae strains were isolated, and 47 children (37%) were colonized with 2 or more genetically distinct H. influenzae organisms. Evidence of sharing of the same strain in different children was found in 13 of 15 colonized DCCs and 23% of genotypically unique strains were shared. CONCLUSION: The degree of sharing of H. influenzae among children in this study suggests transmission of these potentially pathogenic microorganisms in day-care centers.     

Relationship of body mass index and prostate specific antigen in a population-based study

This study was designed to use a prospectively analyzed, population-based, multiethnic cohort of men to determine if there is a relationship between one measure of obesity/overweight (Body Mass Index) and Prostate Specific Antigen (PSA). A total of 1565 men without a prior diagnosis of prostate cancer were prospectively enrolled in the San Antonio study of Biomarkers Of Risk (SABOR) Clinical and Epidemiologic Center of the Early Detection Research Network of the National Cancer Institute. Body Mass Index (BMI) was compared with serum PSA levels, stratifying by ethnic group. No relationship was found between BMI and PSA in any ethnic group or in the cohort as a whole. This study suggests that there is no increased risk of overdetection of prostate cancer among obese men due to an elevation in PSA.     

Influence of ethnicity and language concordance on physician-patient agreement about recommended changes in patient health behavior

The purpose of this study is to examine the association of ethnicity and language concordance with physician-patient agreement about physicians' recommendations for patient health behavior in the following areas: diet, exercise, medication, smoking, stress, and weight. Twenty-seven resident physicians at the University of New Mexico's internal medicine and family practice clinics and 427 of their patients participated. Random effects models were used to estimate the influence of ethnicity and language concordance on whether patients and physicians agreed about specific recommended changes in patient behavior. Ethnicity concordance was not significantly associated with physician-patient agreement. Language concordance positively influenced the likelihood of agreement about exercise but negatively influenced agreement about medications. The lowest percentage of agreement occurred in the area of medication regimens (60%). The results from this study indicate that language is an important barrier to physician-patient agreement, while ethnicity concordance has no effect. However, the influence of whether the physician and patient speak the same language on agreement is unclear and warrants further research.     

Trends in the prevalence and ratio of diagnosed to undiagnosed diabetes according to obesity levels in the U.S

OBJECTIVE: To examine trends in the prevalence of diagnosed and undiagnosed diabetes and the proportion of total cases previously diagnosed, according to obesity status in the U.S. over the past 40 years. RESEARCH DESIGN AND METHODS: We assembled data from five consecutive cross-sectional national surveys: National Health Examination Survey I (1960-1962), National Health and Nutrition Examination Survey (NHANES) I (1971-1974), NHANES II (1976-1980), NHANES III (1988-1994), and NHANES 1999-2000. Diagnosed diabetes was ascertained, and height and weight were measured in adults aged 20-74 years in all surveys. In NHANES II, NHANES III, and NHANES 1999-2000, a fasting glucose level > or =126 mg/dl was used to identify cases among individuals not reporting diabetes. Design-based analyses and Bayesian models estimate the probability that prevalence of diabetes increased within four BMI groups (<25, 25-29, 30-34, and > or =35 kg/m2). RESULTS: In the U.S. population aged 20-74 years between 1976-1980 and 1999-2000, significant increases in the prevalence of diagnosed diabetes (3.3-5.8%, probability >99.9%) were accompanied by nonsignificant increases in undiagnosed diabetes (2.0-2.4%, 66.6%). This resulted in an increase in total diabetes (5.3-8.2%, >99.9%) and a modest nonsignificant increase in the proportion of cases that were diagnosed (62-70%, 62.4%). However, these trends varied considerably by BMI level. In individuals with BMI > or =35 kg/m2, diagnosed diabetes increased markedly (from 4.9% in 1960, to 8.6% during 1976-1980, to 15.1% in 1999-2000; probability >99.9%), whereas undiagnosed diabetes declined considerably (12.5% during 1976-1980 to 3.2% in 1999-2000, probability of increase 4.5%) Therefore, the proportion of total diabetes cases that were diagnosed increased from 41 to 83% (probability 99.9%) among individuals with BMI > or =35 kg/m2. By comparison, changes in prevalence within BMI strata <35 kg/m2 were modest and there was no increase in the percent of total cases that were diagnosed. CONCLUSIONS: National surveys over the last several decades have found large increases in diagnosed diabetes, particularly in overweight and obese individuals, but this has been accompanied by large decreases in undiagnosed diabetes only among individuals with BMI > or =35 kg/m2. This suggests that improvements in diabetes awareness and detection are most prominent among this subgroup.     

Is dietary fat intake related to liking or household availability of high- and low-fat foods?

OBJECTIVE: Despite the increasing availability of low- and reduced-fat foods, Americans continue to consume more fat than recommended, which may be a contributing factor to the obesity epidemic. This investigation examined relationships between liking and household availability of high- and low-fat foods and their association with dietary fat intake. RESEARCH METHODS AND PROCEDURES: A food frequency questionnaire assessed percent calories from fat consumed over the past year in 85 men and 80 women. Participants reported their degree of liking 22 "high-fat foods" (>45% calories from fat) and 22 "low-fat foods" (<18% calories from fat), and the number and percentage (number of high- or low-fat foods/total number of foods x 100) of these high- and low-fat foods in their homes. RESULTS: Hierarchical regression analyses examined the ability of liking and household availability of low- and high-fat foods to predict percent dietary fat intake. After controlling for age, sex, and BMI, liking ratings for high- and low-fat foods and the interaction of liking for low-fat foods by the percentage of low-fat foods in the household were significant predictors of percent dietary fat consumed. Greater liking of high-fat foods and lower liking of low-fat foods, both alone and combined with a lower percentage of low-fat foods in the home, were predictive of higher dietary fat intake. DISCUSSION: Interventions designed to reduce dietary fat intake should target both decreasing liking for high-fat foods and increasing liking for low-fat foods, along with increasing the proportion of low-fat foods in the household.     

A cohort study of former and current Medicaid recipients in two North Carolina counties, 1996-1999

This article presents findings of a 1998-99 resurvey of Medicaid recipients (adults and children) who were first surveyed in 1996 in Mecklenburg and New Hanover Counties in North Carolina. It reports the insurance status and health care of former Medicaid recipients and compares them with those still on Medicaid in 1998-99 in respect to access to care and satisfaction. Just under half of those who had left Medicaid were without employer-sponsored health insurance (ESI) at the time of the second survey. Former Medicaid recipients without ESI rated their access to healthcare lower than those with Medicaid and former Medicaid recipients with ESI. Over 50% of target respondents in all groups were more positive than negative on access-related variables. But only those on Medicaid in Mecklenburg County had significant increases in satisfaction with health care between 1996 and 1998-99. Those in the control county who were off Medicaid and those still receiving it and former recipients in Mecklenburg showed no significant change. The study has great policy relevance in light of recent national welfare reform.     

Duration of untreated psychosis vs. N-acetylaspartate and choline in first episode schizophrenia: a 1H magnetic resonance spectroscopy study at 4.0 Tesla

N-acetylaspartate (NAA) has been associated with neuronal integrity and function, and choline-containing compounds have been linked to neuronal membrane integrity. This study examined the influence of the duration of untreated psychosis, duration of prodromal symptoms and total length of untreated illness on these markers of neuronal loss or damage. In vivo 1H magnetic resonance spectroscopy data were acquired from 1.5-cc volumes in the left anterior cingulate and left thalamus of 19 never-treated first episode schizophrenic subjects using STEAM20 at 4.0 Tesla. Duration of untreated psychosis, prodrome and total length of untreated illness were correlated with levels of NAA and choline. No significant correlation was observed between NAA and duration of untreated psychosis and untreated illness in both regions examined. Thalamic NAA negatively correlated with duration of prodromal symptoms. A positive correlation between choline and duration of untreated psychosis was identified in both regions studied. Delays in treatment of psychotic symptoms of schizophrenia were not associated with a reduction in markers of neuronal integrity or function in contrast to longer prodromal periods, which were associated with lower NAA. Neuronal damage, potentially detectable via lower NAA, may be occurring before the onset of psychosis. Increased choline is associated with longer duration of untreated psychosis and could indicate that psychosis-related membrane alterations precede the appearance of NAA reductions observed by studies of chronic schizophrenia.     

Comparative study of proton and phosphorus magnetic resonance spectroscopy in schizophrenia at 4 Tesla

This study used high-field magnetic resonance spectroscopy to examine the correlation of 1H and 31P metabolite levels in patients with schizophrenia and normal controls. 1H and 31P in vivo spectra were acquired successively from the left anterior cingulate and left thalamus of nine chronic schizophrenic patients and eight comparable healthy controls. A significant positive correlation between glutamine (Gln) and phosphoethanolamine (PEtn) was found in the left anterior cingulate of patients. In the left thalamus of patients, a significant negative correlation between N-acetylaspartate (NAA) and glycerophosphocholine (GroPCho) was found. No significant correlations were found in controls. The correlation between glutamine and phosphoethanolamine may reflect a link between neurotransmission alterations and membrane phospholipid metabolism alterations. The negative correlation between N-acetylaspartate and glycerophosphocholine may reflect the presence of neurodegeneration.