Trends in Tuberculosis Reported From the Appalachian Region: United States, 1993-2005

ABSTRACT:  Context: Appalachia has been characterized by its poverty, a factor associated with tuberculosis, yet little is known about the disease in this region. Purpose: To determine whether Appalachian tuberculosis risk factors, trends, and rates differ from the rest of the United States. Methods: Analysis of tuberculosis cases reported to the Centers for Disease Control and Prevention's National Tuberculosis Surveillance System (NTSS) within the 50 states and the District of Columbia from 1993 through 2005. Results: The 2005 rate of tuberculosis in rural Appalachia was 2.1/100,000, compared to 2.7/100,000 in urban Appalachia. Urban non-Appalachia had a 2005 tuberculosis rate of 5.4/100,000. Over the 13-year period, tuberculosis rates fell in Appalachia at an annual rate of 7.8%. In one age group (15- to 24-year-olds) the rates increased at an annual rate of 2.8%. Foreign-born Hispanics were the largest racial/ethnic group in this age group. When private providers gave exclusive care for tuberculosis disease, Appalachians were less likely to complete therapy in a timely manner when compared to non-Appalachians (OR 0.6, 95% CI 0.5-0.7). Conclusions: Tuberculosis rates and trends are similar in urban and rural Appalachia. It is crucial for public health officials in Appalachia to address the escalating TB rate among 15- to 24-year-olds by focusing prevention efforts on the growing numbers of foreign-born cases. Due to the increased risk of treatment failure among Appalachians who do not seek care from the health department, public health authorities must ensure completion of treatment for patients who seek private providers.     

Moderators of the intention-behaviour and perceived behavioural control-behaviour relationships for leisure-time physical activity

Background  

Intention is a key determinant of action. However, there is a gap between intention and behavioural performance that remains to be explained. Therefore, the aim of this study was to identify moderators of the intention-behaviour and perceived behavioural control (PBC)- behaviour relationships for leisure-time physical activity.     

Epithelial membrane protein‐2 expression is an early predictor of endometrial cancer development

BACKGROUND:

Endometrial cancer (EC) is a common malignancy worldwide. It is often preceded by endometrial hyperplasia, whose management and risk of neoplastic progression vary. Previously, the authors have shown that the tetraspan protein epithelial membrane protein‐2 (EMP2) is a prognostic indicator for EC aggressiveness and survival. Here the authors validate the expression of EMP2 in EC, and further examine whether EMP2 expression within preneoplastic lesions is an early prognostic biomarker for EC development.

METHODS:

A tissue microarray (TMA) was constructed with a wide representation of benign and malignant endometrial samples. The TMA contains a metachronous cohort of cases from individuals who either developed or did not develop EC. Intensity and frequency of EMP2 expression were assessed using immunohistochemistry.

RESULTS:

There was a stepwise, statistically significant increase in the average EMP2 expression from benign to hyperplasia to atypia to EC. Furthermore, detailed analysis of EMP2 expression in potentially premalignant cases demonstrated that EMP2 positivity was a strong predictor for EC development.

CONCLUSIONS:

EMP2 is an early predictor of EC development in preneoplastic lesions. In addition, combined with our previous findings, these results validate EMP2 as a novel biomarker for EC development. Cancer 2010. © 2010 American Cancer Society.     

Tiger‐snake antivenom for suspected small‐eyed snake envenomation

Despite its relative frequency and widespread distribution throughout eastern Australia, bites by the nocturnal eastern small‐eyed snake, Cryptophis nigrescens, have seldom been recorded. There is no standard laboratory test or proven antidote for its venom, which is capable of causing life‐threatening myolysis in humans. A 39‐year‐old man presenting to hospital with acute abdominal and limb muscle pains, was noted to have a pair of puncture wounds on his leg. No venom was detected in the urine with the Commonwealth Serum Laboratories’ Venom Detection Kit. The only blood abnormality was a grossly elevated creatine kinase at 48 000 IU/L. A presumptive diagnosis of Cryptophis nigrescens envenomation was made and the patient treated with tiger‐snake antivenom (3000 U). Creatine kinase levels started to fall almost immediately and the patient made a full recovery. We believe this is the first time tiger‐snake antivenom has been used specifically for suspected Cryptophis nigrescens envenomation.