Using quadratic inference functions to determine the factors associated with obesity: findings from the STEPS Survey in Iran

PurposeThe last study that had a representative sample of the Iranian population and examined the association between sociodemographic and lifestyle factors with obesity used data from the 1999 to 2000 National Health Survey in Iran. Concern about the increased prevalence of obesity has heightened interest in the association between varieties of these factors with obesity among Iranian households.MethodsData (20,917 adults) were taken from the 2009 STEPwise approach to Surveillance survey in Iran that was conducted under the supervision of World Health Organization. Using quadratic inference function, we evaluated the relation of age, sex, physical activity, serving of fruit and vegetable, employment status, smoking, and place of residence with obesity.ResultsUsing 20–30 years as the reference group, the obesity odds ratios (ORs) were 2.48, 3.79, 3.52, and 3.15 for ages 30–40, 40–50, 50–60, and 60+ years, respectively. Obesity OR for female was 2.63, compared with male. Obesity ORs for smokers and ex-smokers were 0.64 and 1.18, respectively, compared with nonsmokers. Among Iranian adult, obesity ORs for the moderate and vigorous physical activity were 0.99 and 0.90, respectively, compared with low level. The estimated odds of obesity were 46% higher for rural adults. Obesity ORs for public and private employed were 0.79 and 0.76, respectively, compared with unemployed.ConclusionsOur results may provide better insights of the factors associated with obesity and can be used as a basis to reinforce health programs to prevent obesity in Iran.     

The association between obesity and migraine in a population of Iranian adults: a case-control study

Aim

To assess the association between obesity and risk of migraine with aura and features of migraine attacks among a population of Iranian adults.

Reduced CD4+,CD25- T cell sensitivity to the suppressive function of CD4+,CD25high,CD127 -/low regulatory T cells in patients with active systemic lupus erythematosus

OBJECTIVE: CD4+,CD25high regulatory T (Treg) cells play a crucial role in the maintenance of self tolerance and prevention of organ-specific autoimmunity. The presence of many in vivo-preactivated CD4+,CD25++ T cells in patients with systemic lupus erythematosus (SLE) poses a difficulty in discriminating CD25++ activated T cells from CD25high Treg cells. To overcome this problem, we analyzed the phenotype and function of CD4+,CD25high,CD127(-/low) natural Treg (nTreg) cells isolated from the peripheral blood of patients with SLE. METHODS: CD4+,CD25high,CD127(-/low) nTreg cells and CD4+,CD25- responder T (Tresp) cells from patients with SLE and normal donors were separated by fluorescence-activated cell sorting. Cell proliferation was quantified by 3H-thymidine incorporation, and immunophenotyping of the cells was done using FACScan. RESULTS: Comparable percentages of CD4+,CD25high,FoxP3+ T cells were observed in patients with SLE and normal donors. Proliferation of SLE nTreg cells sorted into the subset CD4+,CD25high,CD127(-/low) was significantly decreased compared with that of SLE nTreg cells sorted into the subset CD4+,CD25high (mean +/- SEM 2,223 +/- 351 counts per minute versus 9,104 +/- 1,720 cpm, respectively), while in normal donors, these values were 802 +/- 177 cpm and 2,028 +/- 548 cpm, respectively, confirming that effector cell contamination was reduced. Notably, the suppressive activity of nTreg cells was intact in all groups. However, CD4+,CD25- Tresp cells isolated from patients with active SLE were significantly less sensitive than those from patients with inactive SLE to the suppressive function of autologous or normal donor CD4+,CD25high,CD127(-/low) nTreg cells. Furthermore, a significant inverse correlation was observed between the extent of T cell regulation in suppressor assays and the level of lupus disease activity. CONCLUSION: This study is the first to show that, in human SLE, impaired sensitivity of Tresp cells to the suppressive effects of a comparably functional, highly purified nTreg cell population leads to a defective suppression of T cell proliferation in active SLE. Studies aiming to define the mechanisms leading to Tresp cell resistance might help in the development of highly specific, alternative immunotherapeutic tools for the control of systemic autoimmune diseases such as SLE.     

Targeting the Use of Pooled HIV RNA Screening to Reduce Cost in Health Department STD Clinics: New York City, 2009–2011

Objective

Staff at public New York City sexually transmitted disease (STD) clinics screen patients for acute HIV infection (AHI) using pooled nucleic acid amplification tests. AHI screening is expensive but important for populations at high risk of acquiring HIV. We analyzed if targeting AHI screening in STD clinics could reduce program costs while maintaining AHI case detection.

Methods

From January 2009 through May 2010, we screened all patients with negative rapid HIV tests for AHI. Using risk information on cases detected during this universal screening period, we developed criteria for targeted AHI screening and compared case yields and testing costs during 12 months of universal screening (June 2009 through May 2010) vs. 12 months of targeted screening (June 2010 through May 2011).

Results

During the defined period of universal screening, we identified 40 AHI cases, and during targeted screening, we identified 35 AHI cases. Because of targeting efforts, the number needed to test to find one AHI case dropped from 1,631 to 254. With targeted screening, it cost an average of $4,535 per case detected and 39.3 cases were detected per 10,000 specimens; using universal screening, $29,088 was spent per case detected and 6.1 cases were detected per 10,000 specimens processed.

Conclusion

Targeted screening identified similar numbers of AHI cases as when screening all clinic patients seeking HIV testing, but at one-seventh the cost.During the acute phase of human immunodeficiency virus (HIV) infection (AHI), infected people are often unaware of their condition, as AHI symptoms—which include fever, sore throat, fatigue, myalgia, lymphadenopathy, rash, joint pain, night sweats, and diarrhea—are nonspecific.¹ During AHI, patients are highly viremic (and, thus, highly infectious), and antibodies to HIV have not yet developed.² This stage of infection, therefore, is not detected by traditional antibody tests. Detecting AHI requires nucleic acid amplification or antigen tests and enables infected people to adopt safer behaviors and be linked to earlier treatment and care, all of which may reduce HIV transmission.^3,4 A multisite study conducted in 14 clinics in New York City (NYC); Los Angeles, California; and four counties in Florida from 2006 to 2008 found that AHI screening, when added to point-of-care rapid testing, increased HIV detection by 8.2% across all sites; in three NYC clinics, 24% more HIV infections were detected using AHI screening than with HIV detection using rapid antibody tests alone (seven cases detected by nucleic acid amplification testing [NAAT]; 22 cases detected by rapid test).⁵ NAAT is an important tool for identifying AHI, and NAAT pooling methods (pNAATs) help to contain the costs of screening.⁶ By 2009, the NYC Department of Health and Mental Hygiene (NYC DOHMH) had implemented routine AHI screening via pNAAT for all patients with negative rapid HIV tests in all of its sexually transmitted disease (STD) clinics. At that time, the NYC DOHMH joined just a handful of state and local health departments in the United States that were routinely using pNAAT.⁷While AHI screening increased HIV detection in NYC STD clinics, it came at a considerable cost. Annualized other-than-personnel costs of this screening were more than $1 million, or approximately $30,000 per new diagnosis, which was as much as 16 times greater than the average cost of routine opt-out HIV screening in health-care facilities in the U.S.⁸ We present our evaluation of a strategy to reduce program costs while maintaining a high level of AHI case detection among clinic patients.     

Ethanol Modulates Metastatic Potential of B16BL6 Melanoma and Host Responses

The experimental metastatic potential (lung-colonizing ability) of B16BL6 melanoma cells was examined in C57BL/6 mice after exposure to ethanol in vitro and in vivo. In vitro, tumor cells were cultured with ethanol (0.3% v/v), or medium alone, for three passages at 5-day intervals. In vivo, B16BL6 melanoma was exposed to ethanol by administering ethanol (10% or 20% w/v) to mice following subcutaneous inoculation of tumor cells into the dorsal hip. All tumor cells were subsequently inoculated intravenously into the lateral tail vein of water-drinking mice to assess changes in metastatic phenotype. Tumor cells cocultured in vivo with ethanol produced significantly higher numbers of superficial lung colonies, compared with tumor cells cultured in control medium. Experimental metastasis of tumor cells obtained from 20% w/v ethanol-consuming mice was also significantly increased, compared with cells obtained from water-drinking mice. Metastasis of B16BL6 melanoma cells previously obtained from mice consuming 10% w/v ethanol did not differ from controls. In other experiments, water-drinking and ethanol-consuming (2.5%, 10%, and 20% w/v) mice were inoculated subcutaneously into the dorsal hip with B16BL6 melanoma cells, and monitored for tumor growth rate and survival time. In these experiments, survival times were significantly shorter in mice consuming 20% ethanol, compared with all other groups. Subcutaneous tumor growth rate was unaffected by ethanol consumption. Lung metastasis resulting from subcutaneous tumor implantation of B16BL6 melanoma was respectively inhibited, or absent, in 10% and 20% ethanol-consuming groups. Thus, tumor growth rate and incidence of lung metastases were not apparent determinants of decreased survival in 20% ethanol-consuming mice. The results of this study indicate that the experimental metastatic potential of B16BL6 melanoma is increased during exposure to ethanol; however, metastasis from subcutaneous tumor-bearing mice is suppressed. This latter finding is consistent with previous results in which spontaneous metastasis was also suppressed after inoculation of the tumor into the pinna of the ear. Although ethanol increases the ability of B16BL6 melanoma to colonize the lung after intravenous inoculation, this effect is abated in the presence of host factors in ethanol-consuming mice.     

In vivo microscopy of the cerebral microcirculation using neonatal allografts in hamsters

Studies were performed to characterize the morphology and vascular reactivity of the allografted cerebral microcirculation. Cerebral cortical tissue was allografted into the cheek pouch of the hamster so that cerebral parenchymal vessels could be studied. The vascular morphology was characterized by a large number of looping vessels. The ultrastructural examination indicated viable cerebral tissue containing typical vessels, that is, "tight" junctions, not like those of the cheek pouch. Also, the microvasculature was impermeable to 150, 70, and 20 kDa fluorescein isothiocyanate dextrans. Angiotensin II and norepinephrine caused constriction of the cerebral vessels whereas adenosine caused dilation. Isoproterenol did not affect cerebral arterioles; however, it dilated cheek pouch arterioles. Thus, this preparation provides a satisfactory model for studying the living cerebral microcirculation.